bluuebunny/crossref_metadata_2025 huggingface dataset:
Spinal cord contusion injury: experimental dissociation of hemorrhagic necrosis and subacute loss of axonal conduction
Authors: Anderson Thomas E.
Published: May 2009

✓ Previously reported experimental models for spinal cord contusion injury do not allow the independent control of compression and contact velocity required for interpretation of experimental data relating kinematics of vertebral injury to spinal cord injury. Therefore, controlled dynamic compression of the spinal cord was used to study compression and contact velocity as independent variables. Cord conduction was assessed using the latency of somatosensory evoked potentials in response to hindlimb stimulation. The latency increase at 4 hours after contusion differed significantly between control and 50% compression results, and between 25% and 50% compression results. A small nonsignificant increase in latency was observed with increase in contact velocity. The extent of hemorrhagic necrosis correlated with contact velocity rather than with the amount of compression. This study demonstrates, for the first time, a dissociation between hemorrhagic necrosis and loss of neuronal conduction in the subacute phase. Although long-term effects of hemorrhagic necrosis on cord structure and conduction remain to be evaluated, the data suggest that delayed loss of neuronal conduction seen clinically may result from moderate levels of cord compression at high contact velocity. Such an injury is not reproducible by weight-drop techniques for cord injury.
One-stage excision of high-flow arteriovenous malformations
Authors: Bonnal Joël , Born Jacques-Daniel , Hans Pol
Published: May 2009

✓ The authors describe two cases of high-flow arteriovenous malformations which illustrate a new technique to reduce the risk of brain swelling and diffuse hemorrhage during or after operation. This technique, used in the latter of the two cases, includes occlusion of the shunt, followed by the progressive tightening of a Selverstone clamp placed on the cervical internal carotid artery, lowering of the systemic arterial pressure, and the use of barbiturate anesthesia. Clamping and anesthesia are maintained for a 24-hour period after surgery.
Craniopharyngioma with erosion and drainage into the nasopharynx
Authors: Maier Herbert C.
Published: May 2009

✓ This physician had a craniopharyngioma which was treated by radiation therapy in 1938, with relief of headaches and return to professional activity. Later, penetration of the tumor through the sphenoid sinus into the nasopharynx resulted in the intermittent drainage over 30 years of cystic parts of the tumor into the nasopharynx and from there to the oropharynx without any meningeal rupture. Radiation therapy was the initial mode of treatment, later combined with steroid and thyroid replacement therapy. A professional career was possible in spite of the patient's health problems.
Conus ganglioglioma in a 2½-year-old boy
Authors: Wald Uriel , Levy Pavel J. , Rappaport Zvi H. , Michowitz Shalom D. , Schuger Lucia , Shalit Mordechai N.
Published: May 2009

✓ Gangliogliomas are rare tumors, primarily seen in patients under the age of 30 years. They occur least commonly in the spinal cord. This report presents a 2½-year-old boy who harbored an intramedullary conus tumor with the light microscopic appearance of a ganglioglioma. The neurobiological behavior of this tumor is yet to be determined.
Successful stereotaxic evacuation of an acute pontomedullary hematoma
Authors: Bosch D. Andries , Beute Gustaaf N.
Published: May 2009

✓ A healthy young woman developed a rapidly progressive pontomedullary lesion 24 hours after delivery of her first child. The lesion was shown on computerized tomography (CT) to be a primary hematoma. Stereotaxic aspiration was carried out, and the patient recovered. Angiography and CT scanning demonstrated a vascular lesion compatible with an arteriovenous malformation.
Radical excision of craniopharyngioma
Authors: Symon Lindsay , Sprich William
Published: May 2009

✓ A series is presented of 20 craniopharyngioma patients who were treated between 1977 and 1981. All 20 cases underwent radical tumor resection via a frontotemporal craniotomy, with a concomitant temporal tip resection. All operations were performed by the senior author. The operative mortality rate was 5%, and the major morbidity rate 22.2%. The average follow-up period was 3.1 years. The role of radical surgical extirpation in adults is emphasized: the results compare favorably with the current radiotherapeutic and more conservative surgical statistics.
Methylprednisolone half-life during simultaneous barbiturate treatment and mechanical hyperventilation of neurosurgical patients
Authors: Gabrielsen Jørgen , Bendtsen Asger , Eriksen Henrik , Andersen Steen
Published: May 2009

✓ The pharmacokinetics of methylprednisolone sodium succinate (MP) were studied in six neurosurgical patients under intensive treatment with large doses of MP, barbiturates, and mechanical hyperventilation. The study showed a remarkable level of enzyme induction within 24 hours after starting treatment, when the first blood samples were taken. The half-life (t½) for MP during barbiturate and hyperventilation therapy was found to be reduced by a mean 55% (p < 0.01) in relation to the t½ of MP when administered alone. Studies on the day after termination of barbiturate intake indicated a tendency for an increase in the t½ of MP, but it was not significantly different from the pretermination assessment (p > 0.05). On the basis of this study it is not possible to determine if the change in t½ alone is governed by enzyme induction or by a combination of this plus a change in the distribution and clearance of the steroid. The clinical implication of these findings is that patients who are undergoing steroid treatment and at the same time are sedated with barbiturates should have their MP dose increased in order to compensate for the marked reduction of t½ of MP.
Outcome from severe head injury in children and adolescents
Authors: Berger Mitchel S. , Pitts Lawrence H. , Lovely Mary , Edwards Michael S. B. , Bartkowski Henry M.
Published: May 2009

✓ A consecutive series of 37 children (17 years old and under) with severe head injury is presented. The data confirm that morbidity and mortality are lower in children than in adults: 51% of these young patients had a good recovery or moderate disability at 6 months. The mortality rate in this series (33%) is higher than in some reports, but probably more closely approximates the death rate from these injuries in an unselected pediatric population than do statistics from tertiary care hospitals. There was no significant relationship between age and outcome in this age group, but mass lesions and uncontrolled intracranial hypertension adversely affected outcome. Diffuse cerebral swelling was commonly seen on computerized tomography scans, and generally was associated with a satisfactory outcome (75%). Two of 13 deaths were considered preventable, emphasizing the narrow therapeutic safety margin and extreme care required in treating these patients.
Implications of nimodipine prophylaxis of cerebral vasospasm on anesthetic management during intracranial aneurysm clipping
Authors: Stullken Edward H. , Johnston William E. , Prough Donald S. , Balestrieri Francis J. , McWhorter Joe M.
Published: May 2009

✓ Nimodipine, a calcium entry blocking agent similar in structure to nifedipine but with selective cerebrovascular dilating effects, has potential use in the therapy and prevention of cerebral vasospasm after intracranial hemorrhage. The authors summarize the effects of calcium entry blockers, review the pharmacology of nimodipine, and discuss both the known and possible interactions of oral nimodipine with physical and pharmacological interventions that neuroanesthesiologists employ for patients with cerebral vasospasm during craniotomy for aneurysm clipping.

In a series of 26 patients undergoing aneurysm clipping, the authors found that intraoperative blood pressure tended to be reduced by nimodipine. Although the number of patients was limited by the fact that they were enrolled in a multi-center nimodipine aneurysm study and thus had to meet the criteria for that study, it is concluded that prophylaxis of cerebral vasospasm with nimodipine in patients with ruptured intracranial aneurysm results only in a favorable tendency toward lower systemic blood pressure during craniotomy.
Stereotaxic evacuation of spontaneous intracerebral hematomas
Authors: Kandel Edward I. , Peresedov Vjacheslaw V.
Published: May 2009

✓ The authors describe a new device for removal of intracerebral hematomas, based on the principle of stereotaxic evacuation of these lesions proposed in 1978 by Backlund and von Holst. The optimum parameters of stereotaxic aspiration, including speed of screw rotation and amount of suction, have been determined experimentally. Computerized tomography scanning was used to locate the hematoma site, to assess its volume, and to determine stereotaxic coordinates. A new method of preventing rebleeding is also described. This procedure was used to aspirate hematomas in 32 patients with spontaneous intracerebral hemorrhage, including one case caused by aneurysmal rupture and one secondary to rupture of an arteriovenous malformation. All patients were operated on in a severely comatose or semicomatose state. In all but four cases, the hematomas were almost totally removed. Three patients were operated on twice because of recurrent bleeding. The mortality rate for the series was 22%. A preliminary conclusion is made that this new method is safer and less traumatic than open surgery in most cases of severe intracerebral hematoma.
ICP patterns and isotope cisternography in patients with communicating hydrocephalus following rupture of intracranial aneurysm
Authors: Hayashi Minoru , Kobayashi Hidenori , Kawano Hirokazu , Handa Yuji , Yamamoto Shinjiro , Kitano Tetsuo
Published: May 2009

✓ Intracranial pressure (ICP) was continuously recorded, isotope cisternography was performed, and the ventricular system size was evaluated on serial computerized tomography scans in 39 patients. All of these patients had communicating hydrocephalus after subarachnoid hemorrhage (SAH) from rupture of an intracranial aneurysm. The studies were carried out in both the acute stage (within 7 days after SAH) and the communicating hydrocephalus stage. In patients in the acute stage who had no ventricular dilatation, but who later developed communicating hydrocephalus, the resting ICP was high, and an ICP pattern of B-wave activity was seen; there was no delay in cerebrospinal fluid (CSF) absorption on isotope cisternography. Patients with communicating hydrocephalus in whom ICP recordings were started within 63 days after SAH had a pattern of plateau waves in conjunction with B-waves, and there was a marked delay in CSF circulation. In general, patients with higher resting ICP's had more frequent ICP irregularities. Patients with communicating hydrocephalus in whom recordings were begun more than 6 months after SAH had a low and flat ICP pattern, and there was no delay in CSF absorption in spite of bilateral convexity blocks on isotope cisternography. The results suggest that the ICP pattern of plateau waves in conjunction with B-waves can be regarded as a sign of delayed CSF absorption; hence, shunting procedures may be indicated in patients with plateau waves in conjunction with B-waves visualized on continuous ICP recordings.
Pattern-reversal visual evoked potentials in patients with hydrocephalus
Authors: Alani Shakir M.
Published: May 2009

✓ Pattern-reversal visual evoked potentials (VEP's) in response to whole- and half-field stimulation were studied in 10 patients with hydrocephalus. Abnormalities consistent with optic nerve dysfunction were recorded in four patients. Two patients had response asymmetry to half-field stimulation, which suggested dysfunction of the visual pathway in the right hemisphere. The remaining four patients had normal responses. Measurement of VEP's was repeated after the surgical treatment of hydrocephalus in four patients, and showed marked improvement in two of the three patients with preoperative abnormalities. This study suggests that, in patients with hydrocephalus, VEP's are more sensitive than clinical methods in detecting visual pathway dysfunction and that they can be useful in the follow-up monitoring of surgically treated hydrocephalic patients.
Hypothalamic hamartoma successfully treated by operation
Authors: Kyuma Yoshikazu , Kato Ei , Sekido Kenichi , Kuwabara Takeo
Published: May 2009

✓ An 18-month-old boy was diagnosed as having a hypothalamic hamartoma. When he was 1 year old, he developed precocious puberty, and at 18 months old, endocrinological tests revealed abnormally high folliclestimulating hormone, luteinizing hormone, and testosterone levels. The center of the hamartoma was subtotally excised, as confirmed on the postoperative computerized tomography scan. Precocious puberty subsided after the operation.
Fibroblastic tumor of the abducens nerve
Authors: Nehls Daniel G. , Sonntag Volker K. H. , Murphy Alan R. , Johnson Peter C. , Waggener John D.
Published: May 2009

✓ Tumors of the cranial nerves are uncommon, and are usually schwannomas or neurofibromas. The authors describe a case of a fibroblastic tumor involving the sixth cranial nerve. Based upon electron microscopy and immunohistochemistry, the tumor was not of nerve-sheath origin, but was comprised of fibroblasts. Clinical, radiographic, and pathological material are presented, and the literature is discussed. This represents the third case report of a tumor of the abducens nerve, and the first report of a fibroma of a cranial or peripheral nerve.
Postirradiation cerebellar glioma
Authors: Raffel Corey , Edwards Michael S. B. , Davis Richard L. , Ablin Arthur R.
Published: May 2009

✓ A 13-year-old girl developed an anaplastic astrocytoma of the cerebellum 7 years after irradiation of the central nervous system and prophylactic chemotherapy for acute lymphocytic leukemia. The fact that the astrocytoma was anaplastic and infiltrative was unusual for astroglial tumors at this site. It is proposed that this is a radiation-induced glioma.
Retraction system for transsphenoidal surgery
Authors: Kobayashi Shigeaki , Sugita Kenichiro , Takemae Toshiki , Tanizaki Yoshio
Published: May 2009

✓ A retraction system has been developed for transsphenoidal surgery to use together with a conventional self-retaining speculum. The system comprises an attachment to the speculum, a self-retaining retractor, and a slim tapered brain spatula and pronged hook. The spatula or hook is secured with the self-retaining retractor and the attachment. The retractor can also be fixed to the Sugita multipurpose head frame. The system may be used to retract the bulging diaphragma sellae and tumor tissues, and to stop bleeding from the dural venous sinus or tumor bed, so the surgeon can continue the procedure with both hands.
Revascularization of the extracranial vertebral artery at any level without cross-clamping
Authors: Senter Howard J. , Bittar Sami M. , Long Edwin T.
Published: May 2009

✓ Hemodynamic insufficiency resulting from extracranial vertebral artery stenosis or occlusion is believed to be the major cause of vertebrobasilar transient ischemic attacks. The major difficulties in treating this disorder have been exposure of the vertebral artery distal to the stenosis and the risk of vertebral artery cross-clamping for vein grafting or carotid artery transposition. The authors describe a new technique for vertebral artery reconstruction at any level by the use of an intraluminal shunt, thus avoiding the necessity to cross-clamp the artery. This procedure was successfully performed at all three levels of the extracranial vertebral artery: C7-4, C3-1, and C-1 to the foramen magnum. The technique of exposure of the vertebral artery at these three levels and the method of vein grafting without cross-clamping are described. The initial results of the procedure are presented.
Anterolateral decompression for metastatic epidural spinal cord tumors
Authors: Overby M. Chris , Rothman Allen S.
Published: May 2009

✓ Since 1981, 12 patients with epidural spinal cord compression from metastatic carcinoma have been treated surgically by a modified costotransversectomy approach for anterolateral decompression. Before surgery, all patients had received dexamethasone, and had deteriorated neurologically despite radiation therapy, chemotherapy, or steroid therapy. Postoperatively, nine patients (75%) improved neurologically and were ambulatory, two (17%) had no change in neurological status, and one patient was unchanged initially but deteriorated and died 8 weeks later. Anterolateral decompression by a modified costotransversectomy approach should be considered for management of ventrally located tumors or when posterior stabilization is considered a possible requirement following a proposed anterior decompression.
Clinical and histopathological characteristics of gonadotropin-producing pituitary adenomas
Authors: Miura Masaki , Matsukado Yasuhiko , Kodama Takafumi , Mihara Yohsuke
Published: May 2009

✓ The clinical and histopathological characteristics in six cases of gonadotropin-producing adenoma are presented. Definitive diagnosis was made by the determination of gonadotropin levels in culture medium. Several authors have reported that gonadotropin-producing adenomas are very rare; however, hormonal assay of adenoma cell culture medium may indicate the real incidence of gonadotropin-producing adenomas to be greater than is thought. In reported cases, practically no endocrinological symptoms have been found suggesting increased gonadotropin levels, and basal values of plasma gonadotropins have been reported as only slightly over the normal range. Gonadotropin-producing adenomas may have been misdiagnosed as nonsecreting adenomas.

The clinical characteristics of gonadotropin-producing adenomas can be summarized as follows: 1) a tendency for more rapid growth than nonsecreting adenomas; 2) prominent suprasellar extension with marked enhancement on computerized tomography; and 3) diminished response of luteinizing hormone (LH) alone in response to LH-releasing hormone (LH-RH) stimulation, and the ratio of peak follicle-stimulating hormone to peak LH in the LH-RH stimulation test is more frequently over 1:1 in cases of gonadotropin-producing adenoma than in cases of nonsecreting adenoma and craniopharyngioma. Immunoperoxidase staining revealed two kinds of adenoma cells, one intensely and the other faintly stained. Abundant mitochondria and few secretory granules were characteristic electron microscopic features. Oncocytic transformation of adenoma cells was suggested by immunoperoxidase staining and the electron microscopic appearance, and may suppress the elevation of circulating plasma gonadotropin levels. Thus, hormonal assay of adenoma cell culture medium and immunoperoxidase staining are essential for definitive diagnosis of gonadotropin-producing adenomas.
Electrical stimulation of the brain in treatment of chronic pain
Authors: Young Ronald F. , Kroening Richard , Fulton Wayne , Feldman Robert A. , Chambi Israel
Published: May 2009

✓ Forty-eight patients underwent electrical stimulation of the brain for treatment of chronic pain between 1978 and 1983. Average pain duration prior to treatment was 4.5 years. Before selection for this procedure patients underwent pain treatment in a multidisciplinary pain center, intensive psychological and psychiatric evaluation, and assessment of pain responsiveness to intravenous administration of placebo, morphine, and naloxone. A total of 71 electrodes were placed in the 48 patients at a variety of stimulating targets, including the periaqueductal gray matter, periventricular gray matter, thalamus, and internal capsule.

Seventy-two percent of patients experienced complete or partial pain relief. In addition, 59% of patients were able to discontinue narcotic usage. Twenty-five percent of patients returned to normal physical activities and another 33% showed marked improvement in functional capacity. Follow-up periods ranged from 2 to 60 months; with a mean follow-up period of 20 months. A variety of relatively minor complications occurred, but no mortality or permanent sequelae were experienced. No patient's pain was made worse as a result of electrical stimulation. Electrical stimulation of the brain offers a safe and relatively effective method for the treatment of chronic pain in appropriately selected patients, who are unresponsive to other forms of therapy.
Immunohistochemical study of metastatic brain tumors with astroprotein (GFAP), a glia-specific protein
Authors: Yoshimine Toshiki , Ushio Yukitaka , Hayakawa Toru , Hasegawa Hiroshi , Arita Norio , Yamada Kazuo , Jamshidi Jamshid , Mogami Heitaro
Published: May 2009

✓ Tissues from 12 metastatic tumors of the brain were studied immunohistochemically with an antiserum to a glia-specific protein, astroprotein (glial fibrillary acidic protein, GFAP). Emphasis was laid on demonstrating the tissue architecture of metastatic lesions incorporating brain-derived components (astrocytes and glial fibers). Of 12 samples, 11 manifested a number of irregular indentations at the tumor surface. These indentations, which contained astrocytic elements, extended into the tumor tissue in a tapering fashion. In seven cases, the deeper stromal portions of the tumor also contained astroprotein (GFAP)-positive elements. The presence of this glia-specific protein suggests that the stroma of the tumor tissue may in part be derived from preexisting brain tissue. This peculiar tissue architecture of the tumor supports the hypothesis that some of the blood vessels that are located in the stroma of the tumor tissue are also derived from the brain. These observations may be important in understanding the partial preservation of the blood-brain barrier in metastatic brain tumors and the mode of growth of the metastatic lesion, and in selecting the type of chemotherapy that will be most effective in controlling this central nervous system complication of systemic malignancies.
Hemiparesis caused by vertebral artery compression of the medulla oblongata
Authors: Kim Phyo , Ishijima Buichi , Takahashi Hiroshi , Shimizu Hiroyuki , Yokochi Masayuki
Published: May 2009

✓ The case is reported of a patient with progressive left hemiparesis due to vascular compression of the medulla oblongata. Metrizamide computerized tomography cisternography revealed that the left vertebral artery was compressing and distorting the left lateral surface of the medulla. Compression was surgically relieved and symptoms improved postoperatively. Neurological and symptomatic considerations are discussed in relation to the topographical anatomy of the lateral corticospinal tract.
Positional intermittent occlusion of the internal carotid artery
Authors: Nehls Daniel G. , Marano Stephen R. , Spetzler Robert F.
Published: May 2009

✓ A case of angiographically verified positional occlusion of the internal carotid artery is presented. A small web-like atherosclerotic plaque was found to be responsible for producing the intermittent occlusion. Endarterectomy was curative. The clinical implications of the case are discussed.
Neurological manifestations of the acquired immunodeficiency syndrome (AIDS): Experience at UCSF and review of the literature
Authors: Levy Robert M. , Bredesen Dale E. , Rosenblum Mark L.
Published: May 2009

✓ In this review of the acquired immunodeficiency syndrome (AIDS), the authors have evaluated a total of 352 homosexual patients with AIDS or generalized lymphadenopathy managed at the University of California, San Francisco (UCSF), between 1979 and 1984. Of an initial unselected group of 318 patients, 124 (39%) were neurologically symptomatic, and one-third already had their neurological complaints at the time of presentation. An additional 210 AIDS patients with neurological symptoms have been reported in the literature. Thus, a total of 366 neurologically symptomatic patients with AIDS or lymphadenopathy are reviewed.

Central nervous system (CNS) complications, encountered in 315 patients, included the following viral syndromes: subacute encephalitis (54), atypical aseptic meningitis (21), herpes simplex encephalitis (nine), progressive multifocal leukoencephalopathy (six), viral myelitis (three), and varicella-zoster encephalitis (one). Non-viral infections were caused by Toxoplasma gondii (103), Cryptococcus neoformans (41), Candida albicans (six), Mycobacteria (six), Treponema pallidum (two), coccidioidomycosis (one), Mycobacterium tuberculosis (one), Aspergillus fumigatus (one), and Escherichia coli (one). Neoplasms included primary CNS lymphoma (15), systemic lymphoma with CNS involvement (12), and metastatic Kaposi's sarcoma (three). Cerebrovascular complications were seen in four patients with hemorrhage and five with infarction. Five patients in the UCSF series had multiple intracranial pathologies, including two cases of simultaneous Toxoplasma gondii infections and primary CNS lymphoma, two cases of coexistent Toxoplasma gondii and viral infections, and one case of combined Toxoplasma gondii and atypical mycobacterial infection.

Cranial or peripheral nerve complications, seen in 51 patients, included cranial nerve syndromes secondary to chronic inflammatory polyneuropathy (five), lymphoma (five), and Bell's palsy (five). Peripheral nerve syndromes included chronic inflammatory polyneuropathy (12), distal symmetrical neuropathy (13), herpes zoster radiculitis (six), persistent myalgias (two), myopathy (two), and polymyositis (one).

In light of the protean behavior of AIDS and the problems related to the clinical, radiological, and serological diagnosis of the unusual and varied associated nervous system diseases, patients with AIDS and neurological complaints require a rigorous and detailed evaluation. The authors' experience suggests that biopsy of all CNS space-occupying lesions should be performed for tissue diagnosis prior to the institution of other therapies.
Treatment of craniopharyngiomas in children: 1972–1981
Authors: Fischer Edwin G. , Welch Keasley , Belli James A. , Wallman James , Shillito John J. , Winston Ken R. , Cassady Robert
Published: May 2009

✓ Between 1972 and 1981, 37 children with craniopharyngioma were cared for at Children's Hospital, Boston. In this paper, the results of treatment with radiation therapy after conservative operations are compared with those following an initial attempt to excise the tumor. Radiation therapy was equally, if not more, effective than attempted excision in controlling subsequent tumor growth. Although this was not a controlled study, the complications of each approach are indicated, and it is inferred that conservative operations combined with radiation therapy offer less risk for psychosocial impairment than does attempted tumor excision when patients are considered as a group. The ultimate effect that either approach might have on quality of life remains to be defined, and therapy must still be individualized to the particular clinical problem.
Evaluation of treatment of normal-pressure hydrocephalus
Authors: Meyer John S. , Kitagawa Yasuhisa , Tanahashi Norio , Tachibana Hisao , Kandula Prasab , Cech David A. , Clifton Guy L. , Rose James E.
Published: May 2009

✓ Ten patients with dementia due to normal-pressure hydrocephalus were evaluated prospectively according to a planned, longitudinal protocol for 4 to 12 months. Information recorded at each visit included clinical history, medical and neurological examination, psychometric scoring by Mini-Mental Status Questionnaire, measurement of ventricular size and local cerebral blood flow, and partition coefficients (local lambda changes) (lλ) by xenon contrast computerized tomography scanning. Cerebrospinal fluid shunting was carried out in eight cases. Serial evaluations were repeated at intervals up to 8 months after shunting, and demonstrated that the ventricles decreased in size and periventricular hypodensities decreased. White matter lλ values and blood flows and cortical gray matter flows progressively increased for 3 months after shunting, and remained increased except for one case complicated by chronic alcoholism. Clinical recovery correlated with improved cerebral perfusion. There were returns of urinary continence and improvements in gait and usually in activities of daily living. Mentation was the last factor to improve. Factors negatively influencing cerebral perfusion and clinical recovery were shunt failures and various contributing causes of dementia.
Primary central nervous system lymphoma
Authors: Kawakami Yasuto , Tabuchi Kazuo , Ohnishi Rinkichi , Asari Shoji , Nishimoto Akira
Published: May 2009

✓ A retrospective analysis of 21 cases of primary central nervous system (CNS) lymphoma is reported. All patients presented with a solitary mass in the supratentorial region. None had previously received immunosuppressive therapy. Neuroradiological studies included technetium-99m-pertechnetate brain scanning in eight cases, cerebral arteriography in all 21 cases, and computerized tomography (CT) in 14 cases. The characteristic features were increased uptake in brain scans, mass effect in arteriograms, and marked contrast enhancement on CT scans. Abnormal tumor vessels were occasionally seen on arteriography, and subtraction films were usually required to appreciate tumor stain. All patients underwent craniotomy, and histological studies of the tumors showed a diffuse type of lymphoma in all cases. Immunoglobulin testing was performed in 19 cases and a monoclonal spike was verified in 10, suggesting a B cell origin. All patients were followed until their death except one who was still alive 12 months from onset of symptoms. Therapy included subtotal resection in all 21 cases, whole-brain irradiation in six cases, chemotherapy in two cases, and a combination of whole-brain irradiation and chemotherapy in nine cases. Three different forms of chemotherapy were used. The results suggest that chemotherapy is an important addition to subtotal resection and whole-brain irradiation in the treatment of primary CNS lymphoma.
Cause of decline in head-injury mortality rate in San Diego County, California
Authors: Klauber Melville R. , Marshall Lawrence F. , Toole Belinda M. , Knowlton Sharen L. , Bowers Sharon A.
Published: May 2009

✓ Even with an increasing population, there were 100 fewer deaths due to head injury in San Diego County, California, in 1982 compared to 1980. During the 5 years from 1976 to 1980 there was nearly a constant death rate from head injuries, followed in the next 2 years by a decline of 24%. The number of deaths at the scene of injury declined 28%, and the number of individuals listed as dead on arrival at the hospital declined 68%. Mortality rates in the emergency room increased slightly and later death rates declined slightly. Mortality rates of hospitalized patients, adjusted for severity of injury, did not vary materially by year. This decline in deaths due to head injury followed a marked improvement in the county's emergency ground and prehospital air evacuation services. The data strongly suggest that advanced prehospital emergency medical services can substantially reduce mortality rates in head-injured patients. The authors postulate that some patients who ordinarily “would die now talk” because of early airway and circulatory management by highly trained paramedical personnel and airborne trauma specialists. Despite a search for other factors that might explain these observations, no satisfactory alternatives could be identified.
Early operation and overall outcome in aneurysmal subarachnoid hemorrhage
Authors: Ljunggren Bengt , Säveland Hans , Brandt Lennart , Zygmunt Stefan
Published: May 2009

✓ Over a 3-year period, 251 individuals in a population of 1.46 million were known to have suffered an aneurysmal subarachnoid hemorrhage (SAH). Forty-three individuals (17%) were either found dead or were dead on arrival at a hospital or forensic department. Forty-nine patients (20%) were at no stage in their clinical course considered to be surgical candidates. Six patients (2% of the total series) were initially in good condition, but subsequently deteriorated during the acute phase and were not treated surgically. Nineteen poor-risk patients (8% of the total series) underwent emergency surgery because of a life-threatening intracerebral hematoma; 105 patients (42% of the total series or 69% of the surgically treated patients) were operated on at the acute stage, and 29 patients (11% of the total series or 19% of the surgically treated patients) underwent late surgery. Of the total series, 107 patients (42%) recovered without neurological deficits; the overall morbidity rate was 19%, and the mortality rate was 39%. Of 99 Grade I to III patients who were operated on at the acute stage, 76% recovered without neurological deficits, and 4% died. It is concluded that the overall outcome in aneurysmal SAH remains poor, mainly because of the large group of patients who are permanently devastated by their initial bleed.
Intraoperative brain-stem auditory evoked potentials during posterior fossa microvascular decompression
Authors: Friedman William A. , Kaplan Barry J. , Gravenstein Dietrich , Rhoton Albert L.
Published: May 2009

✓ Recent technological advances have led to increased interest in intraoperative evoked potential monitoring. Although theoretically valuable, its precise role remains to be defined, and useful criteria for predicting neurological deficit are not well established. The authors used brain-stem auditory evoked potential (BAEP) monitoring during 21 posterior fossa microvascular decompression procedures to assess the value of this technique in predicting postoperative deficit. The surgeon was notified only if there was complete disappearance of wave V. Although no patients had postoperative deafness, BAEP latencies changed significantly in all cases. In four patients, wave V totally disappeared during cerebellar retraction. The BAEP appears to be a very sensitive monitor of auditory function, such that “false positive” results will be frequent if latency criteria alone are used to trigger alterations in surgical technique.
Immediate effects of spinal cord stimulation in spinal spasticity
Authors: Barolat-Romana Giancarlo , Myklebust Joel B. , Hemmy David C. , Myklebust Barbara , Wenninger William
Published: May 2009

✓ Six patients with intractable spasms after spinal cord injury underwent implantation of an epidural spinal cord stimulation system. All the patients experienced good relief postoperatively. In three patients spinal cord stimulation consistently produced immediate inhibition of the spasms. This was evident within less than 1 minute of stimulation. Conversely, the spasms reappeared within less than 1 minute after cessation of the stimulation. The clinical observations were confirmed by polygraphic electromyographic recordings.
Beagle puppy model of intraventricular hemorrhage
Authors: Ment Laura R. , Stewart William B. , Duncan Charles C.
Published: May 2009

✓ Intraventricular hemorrhage (IVH) represents a major problem for preterm neonates and is thought to occur secondary to alterations in cerebral blood flow (CBF) to damaged germinal matrix tissues. Many investigators believe that both local CBF and changes in capillary morphology and permeability may be partially controlled by prostaglandins. To evaluate this hypothesis, the authors have studied the effects of superoxide dismutase (SOD), a known free-radical scavenger, on newborn beagle pups that were randomly assigned by computer to four groups consisting of either SOD- or saline-pretreated animals that underwent either insult by hemorrhagic hypotension/volume reexpansion or no insult. Prostaglandin levels were determined prior to and 60 minutes following the administration of the solutions, and carbon-14 iodoantipyrine autoradiography was performed for determination of CBF.

It was demonstrated that, although SOD significantly decreased the incidence of IVH in this model (p < 0.05), it caused no alterations in baseline CBF or prostaglandin levels. In addition, SOD did not prevent either the systemic blood pressure changes or the alterations in CBF found in response to a hemorrhagic hypotensive insult. The authors propose that neonatal IVH results from a combination of factors, one of which is prostaglandin-mediated alterations in CBF to a damaged capillary matrix.
Aspiration of blood from the jugular vein during intracarotid drug infusion in monkeys
Authors: Clark W. Craig , Daniels Cheryl E. , Dedrick Robert L. , Girton Mary E. , Doppman John L. , Oldfield Edward H.
Published: May 2009

✓ Circulation of blood in the ipsilateral jugular vein through an extracorporeal circuit for drug removal during intracarotid chemotherapy has recently been reported to decrease the systemic drug exposure. The reduced systemic exposure achieved by the use of this technique should permit a several-fold increase of the intracarotid dose of chemotherapy without increasing systemic toxicity. To determine the influence of the rate of blood removal from the jugular vein on the fraction of the blood flowing through the ipsilateral internal carotid artery (ICA) collected for extracorporeal drug removal, the authors aspirated blood from the jugular bulb into an extracorporeal circuit at varying rates during a constant infusion of the indicator dye, indocyanine green (ICG), into the ICA of rhesus monkeys. The fraction of the ipsilateral carotid blood channeled into the extracorporeal circuit increased linearly with the rate of aspiration of jugular blood. This suggests that the absence of valves in the intracranial venous system should permit increasing fractions of drug removal during intracarotid infusion by increasing the rate of collection of venous blood from the ipsilateral jugular bulb. The measurement of ICG concentrations in a similar manner in patients undergoing isolated perfusion may prove to be a clinically useful method for estimating the maximum safe dose in high-dose intra-arterial chemotherapy.
Lysis of intracranial hematomas with urokinase in a rabbit model
Authors: Narayan Raj K. , Narayan Tina M. , Katz David A. , Kornblith Paul L. , Murano Genesio
Published: May 2009

✓ Urokinase (UK), a potent thrombolytic agent, was tested in a rabbit model for safety and efficacy in lysing intracranial hematomas. Intracerebral-intraventricular (IC-IV) hematomas were created by stereotaxically injecting 0.2 ml of clotted human blood into the frontal lobe and lateral ventricle of a total of 57 anesthetized adult New Zealand White rabbits (weighing 1.6 to 2.5 kg). Control animals received 0.2 ml of normal saline injected into the clot, and the experimental group received an equal volume of UK solution (50,000 units/ml) immediately after the clot injection. Some animals were sacrificed at 3 hours and others at 24 hours postinjection. At 3 hours, clot lysis had been achieved in nine (90%) of 10 UK-treated animals as compared to one (14%) of seven controls. By 24 hours, clots had been lysed in 10 (83%) of 12 UK-treated animals and in two (33%) of six controls. Overall, clot lysis was demonstrated in 19 (86%) of the 22 UK-treated animals and in only three (23%) of the 13 controls (p < 0.001). There was no significant difference in results between these animals and a further set of 22 rabbits that were treated with UK or saline 24 hours after clot injection. There was no histological evidence of damage or inflammation noted on careful light microscopic examination of three to five sections from each brain, although findings consistent with encephalitozoonosis, an incidental protozoan infestation, were encountered in four animals. These studies suggest that UK may be safely and effectively employed for the lysis of intracranial hematomas in this animal model, and that a delay in therapy of up to 24 hours does not significantly compromise its efficacy.
Enlargement of an intracranial aneurysm in the eighth decade of life
Authors: Dacey Ralph G. , Pitkethly David , Winn H. Richard
Published: May 2009

✓ The management of intracranial aneurysms in elderly patients remains controversial, since the natural history of these lesions is not well understood. The authors describe the case of a 76-year-old woman with documented enlargement of an internal carotid artery aneurysm over 3 years. The management of intracranial aneurysms in elderly patients is discussed.
Stereoscopic television system for use with the operating microscope
Authors: Sugita Kenichiro , Ohohigashi Yohji , Kobayashi Shigeaki
Published: May 2009

✓ A new and simple method of stereoscopic television imaging of surgical procedures performed under an operating microscope has been developed. Two television cameras of the same type, two television monitors of the same size, and a mirror box for fusion of the two visual objects on the two television monitors are used. No significant modifications of available components are necessary. The method can be applied to all operating microscopes with a beam splitter.
Emergency embolectomy for acute occlusion of the middle cerebral artery
Authors: Meyer Fredric B. , Piepgras David G. , Sundt Thoralf M. , Yanagihara Takehiko
Published: May 2009

✓ Twenty cases treated with emergency embolectomy for acute occlusion of the middle cerebral artery were reviewed. There were 10 males and 10 females, with an average age of 55 years. The left middle cerebral artery was involved in 17 patients and the right in three. Flow was restored in 16 patients (75%). The embolus originated in the heart in seven, the carotid artery in seven, the aorta in three, an aneurysm in one, and an indeterminate source in two. It was technically most difficult to achieve patency with atheromatous emboli from the aorta. Two patients (10%) had an excellent result with no neurological deficit, five (25%) were left with a minimal deficit but were employable, seven (35%) had a fair result but were still independent and employable, four (20%) did poorly, and two (10%) died. Patients with an associated ipsilateral carotid artery occlusion did poorly. Collateral flow, as judged from preoperative angiograms, was the best predictor of outcome.
The efficacy of radiotherapy for craniopharyngioma
Authors: Manaka Shinya , Teramoto Akira , Takakura Kintomo
Published: May 2009

✓ A series of 125 patients who underwent surgery for craniopharyngiomas was evaluated to assess the efficacy of radiation therapy: 45 patients had received radiotherapy and 80 had not. These patients included all operative survivors (excluding cases with total tumor removal) treated during the 30 years from 1950 to 1979. Median survival time of the irradiated group was greater than 10 years, whereas it was 3.12 years for the nonirradiated (or control) group. The 5- and 10-year survival rates were 88.9% and 76.0% for the irradiated group, and 34.9% and 27.1% for the control group, respectively. Overall comparison, using the Lee-Desu statistical method, revealed that there was a very high statistical significance (at the level of p < 0.0001) in the difference between the survival times of the irradiated and control groups. The influence of the following factors on the effectiveness of radiotherapy was analyzed: age of the patient at the first operation, sex, date of surgery, the extent of tumor removal, the size of the tumor, the composition of the tumor (cystic or solid), whether the tumor was calcified or not, the histological subtype of the tumor, the presence of intracranial hypertension, the grade of visual failure, and the presence or absence of diabetes insipidus, altered mentation, and adiposogenital syndrome. The results indicated that, when total removal of the tumor is impossible, radiotherapy should be administered.
Vocal cord paralysis associated with anterior cervical fusion: considerations for prevention and treatment
Authors: Bulger Richard F. , Rejowski James E. , Beatty Robert A.
Published: May 2009

✓ In a series of 375 patients with anterior cervical fusions, long-term follow-up results complete with laryngeal examination were obtained in 102 patients. One patient was found to have an inferior laryngeal nerve palsy, and one had a superior laryngeal nerve palsy. Both deficits were thought to be the result of surgical trauma. Measures to minimize the incidence of vocal cord paralysis include careful surgical technique and knowledge of the surgical anatomy of the laryngeal nerves. Suggestions are given for the assessment of postoperative hoarseness, and for the management of vocal cord paralysis.
Efficacy of chymopapain chemonucleolysis
Authors: Javid Manucher J.
Published: May 2009

✓ A 9- to 12-year follow-up review was conducted in 105 of 124 patients who were treated with chymopapain chemonucleolysis for herniated lumbar disc. The data were obtained from responses to a questionnaire. Seventy-nine patients (75.2%) reported marked improvement, six (5.7%) had slight improvement, and 20 (19.0%) had no improvement. Of the 87 patients not receiving workman's compensation, 70 patients (80.5%) had marked improvement; four (4.6%) had slight improvement; and 13 (14.9%) had no improvement. Of the 18 compensation cases, nine patients (50.0%) had marked improvement; two patients (11.1%) had slight improvement; and seven patients (38.9%) had no improvement. These results are comparable to those reported for surgical discectomy, and confirm that chymopapain chemonucleolysis is an alternative to surgery.
A combined epi- and subdural direct approach to carotid-ophthalmic artery aneurysms
Authors: Dolenc Vinko V.
Published: May 2009

✓ A series of 14 patients with a carotid-ophthalmic artery aneurysm were treated operatively. In five patients the aneurysms were large, but only one of these had ruptured; four of these patients had symptoms of mass lesions. The remaining nine patients were operated on for a ruptured aneurysm; seven had subarachnoid hemorrhage due to the carotid-ophthalmic artery aneurysm and two had bleeding from another aneurysm in the presence of an asymptomatic carotid-ophthalmic artery aneurysm. All patients were treated by a combined epi- and subdural direct surgical approach, which excluded the carotid-ophthalmic artery aneurysm from the circulation and made possible the preservation of the adjacent structures. Two patients died: one a few hours after surgery from a massive thromboembolism of the pulmonary artery and another 2 months after surgery as a result of gastrointestinal bleeding. All the other patients showed postoperative improvement in symptoms and signs. This report focuses on a modified direct surgical approach involving exposure of the internal carotid artery proximal to the lesion, and of the ophthalmic artery, which is of primary importance in securing safe and complete occlusion of a carotid-ophthalmic artery aneurysm. Removal of individual bone structures at the base of the skull provides a better and safer exposure of the central segment of the internal carotid artery than does excessive and hazardous retraction of the brain.