bluuebunny/crossref_metadata_2025 huggingface dataset:
Anterior decompression for ossification of the posterior longitudinal ligament of the cervical spine
Authors: Abe Hiroshi , Tsuru Mitsuo , Ito Terufumi , Iwasaki Yoshinobu , Koiwa Mitsuyuki
Published: May 2009

✓ Anterior decompression and fusion for treating ossification of the posterior longitudinal ligament of the cervical spine was performed in 12 patients. The central part of the vertebral body and the ossified area of the posterior longitudinal ligament were removed by means of a microrongeur and an air drill. The defect was filled with a long bone graft taken from the ilium. The operative results were excellent. Marked improvement of radicular and spinal cord signs was seen in all 12 cases. Three vertebral bodies were fused in one case, four in nine cases, and five in two cases. The highest level of fusion was C-2 and the lowest was T-1. It is considered that any ossification of the ligament below the C-2 level can be removed via an anterior approach as long as no more than five vertebral bodies are involved. Spinal computerized tomography was valuable in providing more detailed information about the stenotic spinal canal and the shape of the ossified ligament.
Intradural disc rupture
Authors: Smith Richard V.
Published: May 2009

✓ Two cases of intradural disc rupture are presented, and 43 cases found in the literature are reviewed. Dandy's original observations concerning this lesion correlate well with contemporary experience. Characteristics of the history and physical findings are uniform enough to suggest a clinically identifiable syndrome. Microscopic examination of the Cytospin cerebrospinal fluid specimen and the use of computerized tomography with metrizamide may suggest the diagnosis preoperatively. Despite significant neurological deficits associated with lumbar lesions, the prognosis following surgery is good.
Pubertas praecox in craniopharyngioma
Authors: Cabezudo José M. , Perez Carmelo , Vaquero Jesús , Garcia-De-Sola Rafael , Bravo Gonzalo
Published: May 2009

✓ A case of craniopharyngioma associated with true precocious puberty is reported in a child operated on when she was 2 years and 8 months of age. Precocity was noted 10 months after operation and was fully documented 1 year later. A pneumoencephalogram showed a recurrence of tumor in the hypothalamic area. Hormonal therapy was instituted to stop sexual maturation. Reoperation was undertaken only when her visual symptoms reappeared. She received a postoperative course of radiotherapy. On last examination, she was neurologically well, and computerized tomography did not show further growth of the residual tumor. The diagnosis of precocious puberty and its etiology in this patient are discussed.
Schwannoma of the trochlear nerve
Authors: Ho Khang-Loon
Published: May 2009

✓ There are only seven reported cases of intracranial schwannomas originating from the cranial nerves innervating the extraocular muscles. The present case, an incidental finding at autopsy, is the third case of schwannoma of the trochlear nerve and the first to illustrate the morphological relationship between this tumor and nerve. Reported cases of schwannoma of the oculomotor and trochlear nerves are summarized in a table.
Recurrent subarachnoid hemorrhage complicating cerebral arterial ectasia
Authors: Goldstein Steven J. , Tibbs Phillip A.
Published: May 2009

✓ A case of subarachnoid hemorrhage (SAH) complicating cerebral arterial ectasia is reported. While ischemia and cranial nerve palsies are commonly associated with this condition, review of the literature reveals that SAH is exceedingly rare. The pathogenesis, radiographic findings, and clinical complications of cerebral arterial ectasia are discussed.
Fluid blood density level demonstrated by computerized tomography in pituitary apoplexy
Authors: Fujimoto Masahito , Yoshino Eiji , Ueguchi Tadashi , Mizukawa Norihiko , Hirakawa Kimiyoshi
Published: May 2009

✓ Two cases of pituitary apoplexy are presented. A fluid blood density level was demonstrated by computerized tomography in a suprasellar ring-enhancing lesion.
Serum prolactin in patients with hypothalamus and pituitary disorders
Authors: Lundberg Per Olov , Osterman Per Olof , Wide Leif
Published: May 2009

✓ Serum prolactin concentrations were studied in 115 patients with anatomically defined disorders in the hypothalamo-pituitary region. Fifty of the patients had expansively growing pituitary adenomas; in 17 of them (13 females and four males) the prolactin values were slightly raised (15 to 100 µg/liter), and in 13 (11 females and two males) they were over 100 µg/liter. The frequency of elevated prolactin values was higher for females than for males. Fifteen patients with invasively growing pituitary adenomas had very high serum prolactin levels (range 1230 to 31,500 µg/liter, geometric mean 3150 µg/liter). In a single case of malignant pituitary adenoma, the serum prolactin was at the lower level of detection.

Of 49 further patients with suprasellar meningiomas, craniopharyngiomas, or other expansive or destructive lesions of the hypothalamus and sellar region, 15 had slightly raised prolactin values (maximum 114 µg/liter). Eight of these 49 patients had sellar destruction, with a roentgenological picture similar to that in patients with invasive pituitary adenomas. Among these eight patients, the maximum prolactin value was 67 µg/liter.

It is concluded that moderately raised serum prolactin values (up to 100 µg/liter) in a patient with a sellar tumor does not prove that the tumor is a prolactinoma. A serum prolactin value of 100 to 1000 µg/liter strongly indicates a prolactin-producing tumor. In a patient with sellar destruction, a serum prolactin value of over 1000 µg/liter is proof that the destruction is caused by an invasive pituitary adenoma.
Effect of naloxone on posttraumatic ischemia in experimental spinal contusion
Authors: Young Wise , Flamm Eugene S. , Demopoulos Harry B. , Tomasula John J. , DeCrescito Vincent
Published: May 2009

✓ The effect of naloxone on blood flow and somatosensory evoked potentials was studied in cats subjected to 400 gm-cm contusion injuries of the thoracic spinal cord. Eight cats were treated with 10 mg/kg naloxone 45 to 60 minutes after injury, 11 cats were given 10 ml of saline instead of naloxone, and six cats were neither injured nor treated. Hydrogen clearance was used to measure blood flow in the lateral white columns at the contusion site.

Naloxone, given intravenously, significantly improved the blood flow rates in the lateral column white matter. At 2 hours after injury, the mean blood flow in the saline-treated cats fell to 50% (p < 0.01) of preinjury flow rates, whereas it increased 6% (p > 0.50) in naloxone-treated cats, and 12% (p > 0.50) in uninjured cats. At the 3rd hour after injury, the respective flows fell 47% (p < 0.01), and 6% (p > 0.50), and increased 15% (p > 0.50) of the preinjury flow rates.

The naloxone-treated cats had striking preservation of sensory function and somatosensory evoked potentials at 24 hours after injury. At 24 hours, responses had returned in all the naloxone-treated cats and in only 11% of the saline-treated cats. The probability of this combination of events occurring by chance is 0.0030. The authors conclude that naloxone may be useful for the treatment of spinal cord injury. The mechanism of the effect is unknown.
Barbiturate-induced coma therapy for focal cerebral ischemia
Authors: Selman Warren R. , Spetzler Robert F. , Roessmann Uros R. , Rosenblatt Judah I. , Crumrine Ralph C.
Published: May 2009

✓ The authors have studied the therapeutic effect of barbiturate coma following middle cerebral artery (MCA) occlusion in primates. The relationship of the efficacy of barbiturate protection to the presence or absence of recirculation was examined. Barbiturate therapy was begun 30 minutes after MCA occlusion. The findings were as follows: 1) barbiturate-induced coma, with its attendant monitoring, was safely tolerated by primates for 96 hours; 2) 6 hours of MCA occlusion followed by recirculation resulted in a neurological deficit that was worse than the neurological deficit produced by permanent MCA occlusion; 3) barbiturate-induced coma for 96 hours, initiated 30 minutes after the onset of MCA occlusion, in the absence of reperfusion, was in fact detrimental; 4) barbiturate-induced coma for 96 hours, initiated 30 minutes after MCA occlusion, with the establishment of reperfusion at 6 hours, provided nearly complete protection from ischemic damage.
Prognostic implications of early multimodality evoked potentials in severely head-injured patients
Authors: Greenberg Richard P. , Newlon Pauline G. , Hyatt Marti S. , Narayan Raj K. , Becker Donald P.
Published: May 2009

✓ Results of multimodality evoked potential (MEP) studies recorded from 100 comatose patients soon after severe head injury were analyzed prospectively, using a previously established grading system, to assess the prognostic value of MEP's with respect to patient outcome, to evaluate the effect of clinically relevant sequelae of head injury on the prediction of outcome by MEP's, and to describe time to clinical recovery as a function of initial MEP grade. Graded MEP's, when recorded in the first few days after head injury, could predict patient outcome at 1 year with approximately 80% accuracy. Exclusion from the analysis of patients who died from causes unrelated to the brain and those with severe systemic complications that occurred after the evoked potentials were recorded improved the accuracy of outcome prediction to nearly 100%. The presence of a mass lesion requiring surgery reduces the probability of good to moderate outcome for a given MEP grade group by approximately 25% to 40% from that seen in patients without mass lesions. The clinical outcome predicted shortly after head injury by MEP grades may not be realized for many months. Patients with mild MEP abnormality (Grade I or II) generally reach their outcome by 3 to 6 months, whereas those with more severe deficits (Grade III) may not show improvement for at least 1 year.
Vasoconstrictor activity in cerebrospinal fluid from patients subjected to early surgery for ruptured intracranial aneurysms
Authors: Boullin David J. , Brandt Lennart , Ljunggren Bengt , Tagari Philip
Published: May 2009

✓ Vasoconstrictor activity was examined in serial samples of cerebrospinal fluid (CSF) obtained from 10 patients undergoing aneurysm clipping within 48 hours after subarachnoid hemorrhage (SAH). There was no close relationship between vasoconstrictor activity in postoperative CSF samples and the patient's clinical condition or angiographic vasospasm. The identity of the vasoconstrictor substance(s) in CSF was not established, but serotonin, histamine, norepinephrine, epinephrine, acetylcholine, or angiotensinII were eliminated as prime vasoconstrictor agents inducing cerebral vasospasm. Differences in the temporal profile of the responses of isolated tissues to CSF from patients with early and late surgery suggested that differing substances were involved in the production of spasm. A correlation between CSF potassium concentrations and vasoactive substances was found, but potassium could not account for vasoconstrictor activity of CSF. A log:linear correlation between total vasoconstrictor activity and total CSF collected could not be explained. Also, because of possible differences in the identity of vasoactive substances in CSF in this study compared to earlier studies, clinical comparisons based on apparent differences in pharmacological potency of CSF were not warranted. Nevertheless, removal of subarachnoid blood by cisternal rinsing seemed to be a useful surgical adjunct.
Compression of the anterior visual system by the gyrus rectus
Authors: Klingele Terence G. , Gado Mokhtar H. , Burde Ronald M. , Coxe William S.
Published: May 2009

✓ A case of meningioma of the anterior falx cerebri is described in which herniation of the gyrus rectus into the suprasellar cistern with compression of the optic chiasm is demonstrated radiographically. Resection of the tumor mass led to recovery of vision.
Posttraumatic syringomyelia
Authors: Oakley John C. , Ojemann George A. , Alvord Ellsworth C.
Published: May 2009

✓ The ninth case of posttraumatic syringomyelia with postmortem confirmation is presented. Onset of symptoms occurred 19 years after the original trauma. A review of the literature with a discussion of postulated mechanisms of syrinx distention follows. The present case differs from previously reported postmortem cases in that there was communication through the medullary parenchyma with the fourth ventricle.
Multiple meningiomas following radiation therapy for medulloblastoma
Authors: Iacono Robert P. , Apuzzo Michael L. J. , Davis Richard L. , Tsai Fong Y.
Published: May 2009

✓ A patient is reported who was found to harbor multiple benign meningiomas 27 years after radiation therapy for medulloblastoma. Thirty-eight cases of meningiomas occurring after radiation are reviewed and analyzed. Statistical data from these cases support the concept of radiation-induced benign tumors.
Intradural tuberculomas of the spinal cord
Authors: Gökalp Hamit Z. , Özkal Ertuğ
Published: May 2009

✓ The incidence of intradural tuberculoma of the spinal cord is rare, and is becoming rarer as medical care improves. Two cases of surgically treated intradural tuberculomas are presented, with a brief review of the literature. The authors recommend surgical treatment, which carries almost no risk of meningitis if antituberculous treatment is given postoperatively.
Prepontine epithelium-lined cyst
Authors: Hirai Osamu , Kawamura Junichiro , Fukumitsu Taro
Published: May 2009

✓ A 30-year-old woman presented with recurrent episodes of severe headache associated with visual disturbances. Neurological examination showed minimal neurological deficits. Angiography, computerized tomography, and radioisotope cisternography revealed a large cyst in the prepontine region, which did not communicate with either the subarachnoid space or the ventricular system. Histologically, the cyst was lined by columnar and/or cuboidal cells, which contained materials positive on periodic acid-Schiff staining. Ultrastructurally, there were two types of cells, ciliated and nonciliated. Characteristic findings were continuous basement membrane, microvilli covered with electron-dense material, several intercellular junctional devices, and an open intercellular space which was occasionally filled with a migrating cell. These findings would support the view that the epithelial cyst with such features was derived from endodermal tissue rather than from neuroepithelium. Electron microscopic examination is indispensable in making a correct diagnosis of intracranial cysts.
Hypothermia and cardiac arrest in the treatment of giant aneurysms of the cerebral circulation and hemangioblastoma of the medulla
Authors: Silverberg Gerald D. , Reitz Bruce A. , Ream Allen K.
Published: May 2009

✓ Hypothermia and elective cardiac arrest may be of benefit during surgery of some technically difficult lesions of the brain. Eight giant aneurysms and one hemangioblastoma of the medulla were operated on with no mortality, using hypothermia and cardiac arrest. All but one aneurysm were excluded from the cerebral circulation, and the hemangioblastoma appeared to be completely excised. Careful attention to clotting factors, depth of hypothermia, and time of bypass were important factors in the success of this series.
Glial membrane potentials and their relationship to [K+]o in man and guinea pig
Authors: Picker Selwyn , Pieper Carl F. , Goldring Sidney
Published: May 2009

✓ Glial cells were studied in vitro in physiologically viable brain slices prepared from tissues obtained during operations for focal epilepsy and brain tumors. The results from human normal and reactive cerebral cortex and glial tumors were compared with those obtained in guinea pig cortex. The resting membrane potential (RMP) or the relationship of RMP to changes in extracellular potassium concentration ([K+]o) were recorded, and the cell was injected iontophoretically with horseradish peroxidase (HRP) for later visualization and correlation with the physiological data. In normal cortex, the marked cells were protoplasmic astrocytes; in reactive cortex, fibrous astrocytes with abnormal processes predominated. The majority of neoplastic glia resembled the reactive astrocytes, except that they showed a pleomorphism that increased with the degree of malignancy. The mean RMP's of glia from normal human and guinea pig cortex, human reactive cortex, and well differentiated astrocytomas were comparable, about −70 mV. In the less differentiated gliomas, the mean RMP's were lower, with the glioblastoma multiforme having the lowest value, −40 ± 7 mV. When the [K+]o was manipulated over a range of 2 to 40 mM/liter, the mean slope of RMP plotted against [K+]o indicated that normal human and guinea pig glia were exclusively permeable to K+ between [K+]o of 4 to 40 mM/liter. In contrast, the mean slope of reactive glia at these [K+]o's was less, suggesting a permeability to one or more additional ions. Below 4 mM/liter, the slopes of both normal and reactive glia showed changes in RMP smaller than the values expected of cells that are permeable only to K+. Like the reactive glia, the slopes derived for neoplastic cells did not indicate an exclusive permeability to K+, and some cells from the glioblastoma multiforme showed no change in RMP when [K+]o was varied.
Craniopharyngiomas: a critical approach to treatment
Authors: Cabezudo José M. , Vaquero Jesús , Areitio Eduardo , Martinez Roberto , de Sola Rafael García , Bravo Gonzalo
Published: May 2009

✓ The authors have conducted a retrospective statistical study in a series of 45 patients with craniopharyngiomas in order to assess the value of different therapeutic approaches. All the patients included in the study were placed in three groups according to their method of treatment: 1) total excision; 2) subtotal excision; and 3) surgery followed by a course of radiotherapy (RT). Symptomatic recurrence was used to define failure of treatment. Of the patients subjected to total excision, 30% experienced recurrence after a mean time of 2 years. Tumors recurred in 71% of those treated by subtotal excision, with a mean time of 2.6 years. Of patients receiving RT in addition to surgery, only 6% had recurrence, after a mean time of 1 year. The authors conclude that the elective treatment for craniopharyngiomas is controlled subtotal surgery plus RT. Total excision should be attempted only if there is a negligible danger of mortality.
Neurosurgical considerations of cysticercosis of the central nervous system
Authors: Stern W. Eugene
Published: May 2009

✓ Infestation of the central nervous system (CNS) by the larval form of Taenia solium can be etiological for one or more of several clinicopathological manifestations. Experience gained from treating 18 patients forms the basis for a classification of this disease and for observations upon therapy. Twenty-three surgical procedures in 15 of the 18 patients provide the foundation for comment on operative treatment in management. Whereas most procedures are palliative, eradication of the CNS disease may be achieved in cases of solitary intraventricular cysts. There has been no operative mortality.
The course of chronic subdural hematomas after burr-hole craniostomy and closed-system drainage
Authors: Markwalder Thomas-Marc , Steinsiepe Klaus F. , Rohner Matthias , Reichenbach Walter , Markwalder Hans
Published: May 2009

✓ A consecutive series of 32 adult patients with chronic subdural hematoma was studied in respect to postoperative cerebral reexpansion (reduction in diameter of the subdural space) after burr-hole craniostomy and closed-system drainage. Patients with high subdural pressure showed the most rapid brain expansion and clinical improvement during the first 2 days. Nevertheless, a computerized tomography (CT) scan performed on the 10th day after surgery demonstrated persisting subdural fluid in 78% of cases. After 40 days, the CT scan was normal in 27 of the 32 patients. There was no mortality and no significant morbidity. Our study suggests that well developed subdural neomembranes are the crucial factors for cerebral reexpansion, a phenomenon that takes at least 10 to 20 days. However, blood vessel dysfunction and impairment of cerebral blood flow may participate in delay of brain reexpansion. It may be argued that additional surgical procedures, such as repeated tapping of the subdural fluid, craniotomy, and membranectomy or even craniectomy, should not be evaluated earlier than 20 days after the initial surgical procedure unless the patient has deteriorated markedly.
Acute changes in regional brain water content following experimental closed head injury
Authors: Tornheim Patricia A. , McLaurin Robert L.
Published: May 2009

✓ A Remington humane stunner was used to deliver blows to the skulls of anesthetized cats. The animals were sacrificed at 30 minutes or 1, 2, or 6 hours after trauma and selected for data collection on the basis of the following two categories of gross intracranial pathology: 1) unilateral contusion, with subarachnoid hemorrhage (SAH); or 2) SAH only. For selected cats, specific gravity was measured in 5- to 10-mg samples of uncontused tissue taken from coronal slices at the level of the frontoparietal suture. The regions tested included dorsal cerebral cortex, subcortical white matter, deep white matter, and caudate nucleus. Specific gravity data from injured animals were compared with those from similar areas in uninjured anesthetized cats to test for cerebral edema. At 30 minutes after head injury, contused hemispheres had significant edema of all areas tested except the caudate nucleus. Edema of the subcortical and deep white matter increased with time after the injury. Increase in water content of the cerebral cortex was transient and appeared unrelated to contusion. The caudate nucleus was edematous only at 6 hours, suggesting movement of fluid from the deep white matter compartment into that nucleus. The hemispheres opposite the contusion and those related to SAH had, with one exception, an absence of edema in the white matter and caudate nucleus, but a transient increase in water content of the cerebral cortex. These findings suggest that, in the presence of contusion, cerebral edema can contribute to brain swelling as early as 30 minutes after closed head trauma. In addition, a transient and minimal cortical edema, perhaps related to ischemia, occurred in all groups of hemispheres examined.
Effect of trigeminal tractotomy on behavioral response to dental pulp stimulation in the monkey
Authors: Young Ronald F. , Oleson Terrence D. , Perryman Kent M.
Published: May 2009

✓ Trigeminal tractotomy near the level of the obex was carried out in 10 macaque monkeys. Behavioral responses were evaluated by a quantitative paradigm measuring lever-press responses to electrical stimulation of the dental pulp or facial skin, and by assessing facial response to cutaneous pin-scratch before and after the tractotomy. Two pharmacological agents, strychnine and L-dopa, were administered and their effect on behavioral responses to these stimuli was studied.

Tractotomy did not produce dental analgesia. Thresholds for escape from cutaneous electrical stimulation of facial skin, however, were elevated, consistent with marked hypalgesia to pin-scratch. The adversive responses to pin-scratch were absent in peripheral portions of the face, but near the midline and inside the oral cavity they were usually decreased or normal. Pharmacological agents caused a reduction in escape thresholds to cutaneous electrical stimulation and a shrinkage or abolition of the zone of analgesia to pinscratch.

The results imply that trigeminal nucleus caudalis, which undergoes deafferentation by tractotomy, may not be essential for processing of nociceptive information from the teeth, oral cavity, and midline facial zones. This finding is contrary to long-held hypotheses concerning facial pain mechanisms. The ability of strychnine and L-dopa to alter nociceptive escape thresholds is consistent with the idea, suggested by Denny-Brown, that facial nociception depends on central summation in the entire spinal trigeminal nucleus from overlapping afferent inputs contained in the trigeminal nerve, other cranial nerves, and the upper cervical nerve roots.
Individual variations in response of human cerebral arterioles to vasoactive substances, human plasma, and CSF from patients with aneurysmal SAH
Authors: Brandt Lennart , Ljunggren Bengt , Andersson Karl-Erik , Hindfelt Bengt
Published: May 2009

✓ The capricious appearance of delayed cerebral vasospasm in some but not all patients with an aneurysmal subarachnoid hemorrhage (SAH) was the stimulus for studying the reactivity of human cerebral arterioles in vitro to various vasoactive agents (prostaglandin F2a, noradrenaline, serotonin, human plasma, and cerebrospinal fluid from patients with aneurysmal SAH). There was a marked variability in response between arterioles from different individuals. The finding of a markedly individual profile in terms of reactivity toward vasoactive substances emphasizes the importance of a human cerebral vessel wall factor in the pathogenesis of cerebral vasospasm.
Existence and localization of adrenergic neurons in meninges from human adults and fetuses
Authors: Iglesias José R. , Marin Jesús , Salaices Mercedes , Pascual Octavio
Published: May 2009

✓ The cerebral and cerebellar pia mater and arachnoid of 90 adults and 15 fetuses have been studied in order to determine whether the number of arachnoidal neural elements is sufficiently high to dismiss the possibility of their being purely heterotopic or displaced structures. With the aid of various histological techniques and formaldehyde (noradrenaline)-induced fluorescence, the presence of a reticulum composed of many short adrenergic neurons was demonstrated, intimately associated with the sympathetic perivascular innervation. Although this network seems to participate in some aspects of peripheral neuroendocrine function, its possible role in physiologically or pathologically regulating cerebral blood flow is as yet unsettled.
Alteration of blood-CSF barrier by tumor invasion into the meninges
Authors: Ushio Yukitaka , Shimizu Keiji , Aragaki Yasuo , Arita Norio , Hayakawa Toru , Mogami Heitaro
Published: May 2009

✓ Cyclophosphamide and 1-(4-amino-2-methyl-5-pyrimidinyl) methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride (ACNU) were found to have an equivalent cytostatic effect in rats with subcutaneous transplants of Walker 256 carcinosarcoma. Rats with meningeal carcinomatosis received a single intravenous dose of cyclophosphamide (30 mg/kg) or ACNU (15 mg/kg) at various times after intracisternal inoculation of 1 × 104 Walker 256 carcinosarcoma cells. Cyclophosphamide, administered 1 day after tumor inoculation, failed to prevent tumor growth in the subarachnoid space. The survival time of these rats was prolonged only 10% to 14% compared to the controls, while ACNU produced a maximum increased survival time of 180%. If administered 2, 3, 4, and 5 days after tumor inoculation, both drugs were effective; cyclophosphamide yielded a maximum increase in median survival time of 109%, 94%, 90%, and 52%, and ACNU 127%, 139%, 240%, and 100%, respectively. These results indicate that the blood-cerebrospinal fluid (CSF) barrier was circumvented in the early stage of subarachnoid tumor growth, although some areas remained where the infiltrating tumor cells were protected from systemically administered drugs by the intact barrier.
Balloon catheter occlusion for cavernous carotid artery injury during transsphenoidal hypophysectomy
Authors: Britt Richard H. , Silverberg Gerald D. , Prolo Donald J. , Kendrick Michael M.
Published: May 2009

✓ During transsphenoidal hypophysectomy for pituitary ablation in a patient with disseminated breast cancer, brisk arterial hemorrhage occurred during separation of adhesions between the pituitary gland and the wall of the cavernous sinus. Hemorrhage was controlled by placement of a Prolo balloon catheter into the internal carotid artery (ICA) that occluded the site of hemorrhage. The patient experienced no neurological sequelae. The cervical ICA was easily exposed for insertion of this double-lumen catheter. With the image intensifier already in position, injection of contrast material through the arteriography lumen allowed precise localization of the site of injury and directed positioning of the balloon for control of the hemorrhage.
Intracranial pressure following optic nerve decompression for benign intracranial hypertension
Authors: Kaye Andrew H. , Galbraith J. E. K. , King John
Published: May 2009

✓ The authors report the case of a patient with benign intracranial hypertension and severe papilledema, who underwent surgery for bilateral optic nerve sheath decompression. No change in the intracranial pressure (ICP) was seen during continuous recording performed before and after the operation. This case supports the contention that the decrease in papilledema and the visual improvements seen following this operation are more likely to be due to decrease in optic nerve sheath pressure than to a generalized decrease in ICP, as suggested by other authors.
Percutaneous technique for insertion of an atrial catheter for CSF shunting
Authors: Ashker Kheder , Fox John L.
Published: May 2009

✓ A percutaneous technique for insertion of the atrial end of a ventriculoatrial shunt is described. The technique utilizes a catheter introducer set with a guide wire for insertion of the atrial catheter through the internal jugular vein.
Creatine kinase isoenzymes in acute brain injury
Authors: Kaste Markku , Hernesniemi Juha , Somer Hannu , Hillbom Matti , Konttinen Aarne
Published: May 2009

✓ Brain-type creatine kinase (CK) isoenzyme (CK-BB) was detected in the serum in 13 out of 26 patients with acute brain injury (50%). The peak of CK-BB activity ranged from 5 to 188 U/liter, constituting, on average, 10.5% of the total CK activity. The highest activities were seen in patients with gunshot wounds. High CK-BB activity was associated with poor prognosis, but minimal CK-BB elevations did not have prognostic significance.

Heart-type creatine kinase isoenzyme (CK-MB) was detected in the serum in 17 out of 26 patients (65%). The peak activity ranged from 5 to 115 U/liter, constituting, on average, 6.6% of total CK activity. Electrocardiograms taken from 20 patients revealed transient T-wave inversions in the precordial leads in four patients; three of them also showed serum CK-MB activity. Subendocardial hemorrhage was detected at autopsy in three of the five CK-MB-positive patients, but in none of the four CK-MB-negative cases. Present findings suggest that acute brain injury may secondarily cause myocardial damage.
Reversible brain-stem dysfunction following acute traumatic subdural hematoma
Authors: Seelig John M. , Greenberg Richard P. , Becker Donald P. , Miller J. Douglas , Choi Sung C.
Published: May 2009

✓ Of 366 consecutive patients with severe head injury, treated and managed by a uniform protocol, 61 (17%) were admitted with signs of severe brain-stem dysfunction. Forty-three of the 61 patients (70%) had surgical mass lesions and 30% had diffuse brain damage. Twelve of the 61 patients (20%) survived, but only six patients made a good to moderately disabled recovery. All six of these patients had a traumatic acute subdural hematoma (SDH). The records of the 20 comatose patients with an acute SDH and severe brain-stem dysfunction were reviewed to discover which factors contributed to functional recovery. The average survivor was operated on within 2½ hours after injury and the nonsurvivors within 4½ hours. Prompt surgical intervention and prudent control of postoperative intracranial pressure were major factors in preventing permanent brain-stem damage, with a significance of p < 0.05 and p < 0.02, respectively. Measurement of multimodality evoked potentials in the early postoperative period correctly distinguished between reversible and irreversible brain-stem dysfunction in six of seven patients.
Risk of bleeding from unruptured aneurysms in cases with multiple intracranial aneurysms
Authors: Heiskanen Olli
Published: May 2009

✓ The author presents a follow-up review of 61 patients with subarachnoid hemorrhage (SAH) and at least two intracranial artery aneurysms, in whom only the ruptured aneurysm had been clipped. During a 10-year follow-up period, seven patients bled from a previously unruptured aneurysm; four of the hemorrhages were fatal. Three additional patients suffered fatal bleeding more than 10 years after the first SAH. The surgical mortality rate when operating on a ruptured aneurysm at this clinic was 4.2% in 1979. Considering that the mortality rate after rebleeding during an average follow-up period of 16 years was 11.5%, operation for unruptured aneurysms seems to have a slight edge over conservative treatment.
Effect of common carotid ligation on giant aneurysms of the internal carotid artery
Authors: Pozzati Eugenio , Fagioli Leo , Servadei Franco , Gaist Giulio
Published: May 2009

✓ The effects of common carotid artery ligation on five giant aneurysms (greater than 2.5 cm in diameter) of the internal carotid artery were studied by computerized tomography (CT). Four aneurysms thrombosed completely and one partially. The CT image of the thrombosed part in giant aneurysms is protean, varying from hyperdensity in the immediate postoperative period to isodensity and finally to inhomogeneously increased or decreased density, the attenuation values depending on the different stages of organization of the thrombus and on calcium deposition.
Effect of subarachnoid hemorrhage on contractile responses and noradrenaline release evoked in cat cerebral arteries by histamine
Authors: Lobato Ramiro D. , Marín Jesús , Salaices Mercedes , Rico Mercedes L. , Sanchez Carlos F.
Published: May 2009

✓ This study analyzes the changes induced by subarachnoid hemorrhage (SAH) on the contractile responses and the noradrenaline release evoked in cat cerebral arteries by histamine. The dose-dependent vasoconstriction induced by histamine on the cerebral arteries of normal cats was significantly reduced by diphenhydramine and phentolamine. When SAH was produced 3 and 7 days before the experiment, the histamine-induced vasoconstriction also decreased. Thereafter, a tendency to normalization in the contractile vascular responses was observed such that 15 days after the hemorrhage it was not significantly different from that found in control animals. The decrease in the contractile responses to histamine provoked by SAH was similar to that seen after pretreatment with intracisternal injections of 6-hydroxy-dopamine.

The amount of radioactivity released by histamine following preincubation with 3H-noradrenaline from the cerebral arteries of cats exposed to SAH 3, 7, and 15 days before the experiment was significantly reduced when compared with controls. Moreover, the basal level of tritium release and the radioactivity retained at the end of the experiment were also decreased after SAH. These decreases were less marked 15 days after SAH. Intracisternal injections of 6-hydroxydopamine 3, 7, and 15 days prior to the assay, and the removal of both superior cervical ganglia 15 days before the experiment, also markedly reduced these three parameters. These results indicate that histamine releases noradrenaline from cat cerebral arteries, and SAH produces a transient denervation of the perivascular adrenergic nerve endings. The inhibition of the histamine-induced vasoconstriction observed after SAH might be explained by the impairment of the indirect adrenergic mechanism involved in the overall contractile response elicited by this amine in cerebral arteries. According to the present findings, histamine does not seem to play a significant role in the production of the cerebral vasospasm occurring after SAH.
The effects of mannitol on blood viscosity
Authors: Burke Allan M. , Quest Donald O. , Chien Shu , Cerri Cesare
Published: May 2009

✓ To determine the effect of mannitol on blood viscosity, serial measurements were carried out on venous blood in patients undergoing craniotomies for intracranial aneurysms. Blood samples were drawn immediately prior to, and 30 minutes, 2, and 4 hours after administration of mannitol. Complete blood counts, serum osmolarities, and erythrocyte microsieving studies were also performed on each sample. Wholeblood viscosity decreased at 30 minutes and 2 hours, but not at 4 hours after mannitol administration. This decrease appeared at high shear rates only, where erythrocyte deformability is critical in determining viscosity. This effect was independent of the hematocrit. Removal of mannitol from the suspension returned red cell deformability to preadministration values, indicating that the increased erythrocyte deformability required the presence of mannitol and the relative hyperosmolarity induced by this agent. The reduced erythrocyte rigidity and subsequent decreased whole-blood viscosity should enhance tissue perfusion in the microcirculation.
Microsurgical anatomy of the supraclinoid portion of the internal carotid artery
Authors: Gibo Hirohiko , Lenkey Carla , Rhoton Albert L.
Published: May 2009

✓ The microsurgical anatomy of the supraclinoid portion of the internal carotid artery (ICA) was studied in 50 adult cadaver cerebral hemispheres using × 3 to × 40 magnification. The ICA was divided into four parts: the C1 or cervical portion; the C2 or petrous portion; the C3 or cavernous portion; and the C4 or supraclinoid portion. The C4 portion was divided into three segments based on the origin of its major branches: the ophthalmic segment extended from the origin of the ophthalmic artery to the origin of the posterior communicating artery (PCoA); the communicating segment extended from the origin of the PCoA to the origin of the anterior choroidal artery (AChA); and the choroidal segment extended from the origin of the AChA to the bifurcation of the carotid artery. Each segment gave off a series of perforating branches with a relatively constant site of termination. The perforating branches arising from the ophthalmic segment passed to the optic nerve and chiasm, infundibulum, and the floor of the third ventricle. The perforating branches arising from the communicating segment passed to the optic tract and the floor of the third ventricle. The perforating branches arising from the choroidal segment passed upward and entered the brain through the anterior perforated substance. The anatomy of the ophthalmic, posterior communicating, anterior choroidal, and superior hypophyseal branches of the C4 portion was also examined.
Conjoined lumbosacral nerve roots
Authors: Epstein Joseph A. , Carras Robert , Ferrar Jose , Hyman Roger A. , Khan Arfa
Published: May 2009

✓ Anomalous L-5 and S-1 nerve roots occur infrequently. If not properly recognized, surgery for entrapment disorders may result in serious neural injury because of an improper surgical approach in exposure and in removing the underlying herniated discs. The diagnosis has been made preoperatively since the introduction of water-soluble myelography because of improved filling of the nerve roots. A herniated disc beneath the bifid root causes extreme pain and disability with marked signs of entrapment because of firm fixation of the conjoined root in the lateral recess between the two pedicles. An underlying herniated disc may not be recognized because of the unique anatomical changes. To properly identify the nature of the lesion, wide exposure by hemilaminectomy is preferred, with unroofing of the lateral recesses and wide foraminal decompression. Eight such patients are reported: seven had herniated discs, and one had lateral recess stenosis with superior facet entrapment. With adequate decompression, all patients made a rapid, uneventful recovery.
Neuropathological and computerized tomographic findings in experimental brain abscess
Authors: Britt Richard H. , Enzmann Dieter R. , Yeager Anne S.
Published: May 2009

✓ The neuropathological progression of brain abscess formation was studied experimentally at sequential stages in dogs, and the findings correlated with the appearance on computerized tomographic (CT) brain scans. The evolution of brain-abscess formation was divided into four stages based on histological criteria: early cerebritis (Days 1 to 3); late cerebritis (Days 4 to 9); early capsule (Days 10 to 13); and late capsule formation (Day 14 and later). The cerebritis stage was characterized by prominent perivascular cuffing by inflammatory cells in the area adjacent to the developing necrotic center. However, the early elements of capsule formation appeared with the presence of fibroblasts by Day 5. The CT scans showed ring-shaped contrast enhancement by Day 3. Delayed scans at 30 minutes revealed diffusion of the contrast material into the developing necrotic center, forming a solid lesion. In lesions that were well encapsulated (14 days and older), five distinct histological zones were apparent: 1) a well formed necrotic center; 2) a peripheral zone of inflammatory cells, macrophages, and fibroblasts; 3) the dense collagenous capsule; 4) a layer of neovascularity associated with continuing cerebritis; and 5) reactive astrocytes, gliosis, and cerebral edema external to the capsule. The CT appearance of well encapsulated abscesses showed a typical ring-shaped contrast-enhancing lesion. On delayed scans, the “ring” did not fill in with contrast enhancement. The diameter of the ring correlated best with the presence of cerebritis (perivascular infiltrates in the adventitial sheaths of vessels surrounding the abscess). The discussion focuses on the relevance of this study to the current management of patients with brain abscess.
Chiari I “malformation”—an acquired disorder?
Authors: Welch Keasley , Shillito John , Strand Roy , Fischer Edwin G. , Winston Ken R.
Published: May 2009

✓ Caudal herniation of the hindbrain, indistinguishable from the Chiari I deformity, may occur after the establishment of spinal subarachnoid shunts and become symptomatic years after the procedure. Examples are presented and others are cited from the literature. It is proposed that the force responsible for the displacement is the difference in pressure between the cranial and spinal compartments. On the basis of these observations and other considerations as well, a similar process, disproportionate absorption of cerebrospinal fluid from the spinal region, might account for the spontaneous form of the Chiari I deformity.
Cerebellar metastasis from a prolactinoma during treatment with bromocriptine
Authors: Martin Neil A. , Hales Martha , Wilson Charles B.
Published: May 2009

✓ A 31-year-old woman developed a cerebellar metastasis from an invasive prolactin-secreting pituitary adenoma while undergoing treatment with bromocriptine. The metastatic tumor was totally excised. Metastatic spread of pituitary tumors within the central nervous system is reviewed briefly.
Subependymoma presenting as subarachnoid hemorrhage
Authors: Changaris David G. , Powers James M. , Perot Phanor L. , Hungerford G. Douglas , Neal George B.
Published: May 2009

✓ Symptomatic subarachnoid hemorrhage (SAH) in a young patient originated in a non-obstructive lateral ventricular subependymoma. A brief review of brain tumors known to cause SAH is discussed. The computerized tomography scans are presented.
Anastomosis between internal carotid artery and anterior cerebral artery with other anomalies of the circle of Willis in a fetal brain
Authors: Milenković Zoran
Published: May 2009

✓ A rare vascular anomaly was found in a 21-week-old fetal brain. It consisted of an anastomotic loop between the internal carotid artery and the anterior cerebral artery. Other variations and anomalies were also found. Anomalies and variations of the circle of Willis are probably genetically determined and develop at an early embryonic stage. They are frequently found in association with other cerebrovascular diseases, such as aneurysms.
Hemostasis and computerized tomography in head injury
Authors: van der Sande J. Jaap , Veltkamp Jan J. , Boekhout-Mussert Ria J. , Vielvoye G. Jan
Published: May 2009

✓ Coagulation studies (plasma fibrinogen, ethanol gelation test, and fibrin-fibrinogen degradation product concentration) and computerized tomography (CT) scan examinations were performed in 55 patients with blunt head injury. The frequency of abnormalities in both coagulation study results and CT scans was higher in patients with severe clinical features and clinical course than in less severely injured patients; in these same patients the coagulation results were abnormal (64%) more frequently than the CT scans (40%). Very high fibrin-fibrinogen degradation product (FDP) concentrations were found to be associated with combined hemorrhagic lesions and mass effect on CT scans, but not with a specific localization of braintissue damage. It was concluded that: 1) FDP concentration reflects the amount of brain-tissue damage rather than its location, and 2) in the absence of other possible causes of disseminated intravascular coagulation, coagulation studies may be more sensitive than CT scanning in demonstrating brain contusion.
Evoked somatosensory potentials to common peroneal nerve stimulation in man
Authors: Chehrazi Bahram , Parkinson Jacqualyn , Bucholz Richard
Published: May 2009

✓ This study was undertaken to identify the normal somatosensory evoked potential pattern from stimulation of the common peroneal nerve in order to provide basic data for clinical use in diagnosis and management of patients with spinal cord lesions. Thirty-four adult volunteers, free of neurological disease, and 12 patients were tested. The recording technique is described and is similar to that reported by Perot. The primary evoked response (P1) was easily visualized in 88% of the recordings from normal subjects. The peak latency of the primary response was 38.9 msec, and the deflection was positive. A vertex potential (P4) was a relatively consistent peak that appeared at approximately 240 msec in 78% of the subjects. Additional components of the waveform are also described and are compared to previous studies. Clinically, the presence of primary response seems to correlate with a favorable neurological outcome, and recovery of the primary response may precede major clinical improvement. The literature is reviewed and results compared to the current study.
Osmotic blood-brain barrier disruption in the posterior fossa of the dog
Authors: Neuwelt Edward A. , Glasberg Mark , Diehl Jan , Frenkel Eugene P. , Barnett Peggy
Published: May 2009

✓ Transient reversible osmotic blood-brain barrier disruption was produced in the posterior fossa of 33 dogs. A percutaneous catheter technique was used for the infusion of hypertonic mannitol into the vertebral artery. Neither the catheter technique nor the osmotic barrier modification resulted in interference with brain-stem function in most animals. The degree of barrier modification achieved by osmotic disruption in the posterior fossa is similar to that previously described for barrier modification of the supratentorial parenchyma. Methotrexate delivered to the brain via the vertebral artery resulted in a drug concentration of 100 to 300 ng/gm brain tissue. When the same amount of drug was given following osmotic blood-brain barrier disruption, brain tissue contained 1100 to 5000 ng of methotrexate/gm of brain tissue. Finally, the adequacy of the blood-brain barrier modification in the posterior fossa was shown to be quantifiable by the amount of enhancement on computerized tomographic scans.