bluuebunny/crossref_metadata_2025 huggingface dataset:
Ossification of spinal arachnoid with unrelated syringomyelia
Authors: Nagpal R. D. , Gokhale S. D. , Parikh V. R.
Published: May 2009

✓ A case demonstrating a combination of ossified spinal arachnoid and syringomyelia is reported. A plea is made for denoting the condition as “ossification of the spinal arachnoid” rather than “spinal arachnoiditis ossificans.”
Measurement of intracardiac pressure through a valve-tipped catheter
Authors: Ekstedt Jan , Nyström Bo , Hugosson Rune , Högström Seth
Published: May 2009

✓ Intracardiac pressure recording is a simple and effective way of obtaining optimal placement of the cardiac catheter during shunting procedures. We have also found this method applicable when using a catheter with a slit in its tip. Pressure waves can be accurately recorded by means of a constant rate liquid flow through the catheter.
A practical technique for monitoring extradural pressure
Authors: Dorsch Nicholas W. C. , Symon Lindsay
Published: May 2009

✓ The authors discuss the technical problems involved in the continuous measurement of intracranial pressure, and describe a simple, inexpensive extradural strain gauge system that can be manufactured by most research units. The system has the merits of coplanar construction, a ready zero reference, and simplicity in design and use. The theoretical limits of the extradural method are presented and discussed in relation to transducer design.
Use of long-term intracranial pressure measurement to assess hydrocephalic patients prior to shunt surgery
Authors: Symon Lindsay , Dorsch Nicholas W. C.
Published: May 2009

✓ The authors present their experience with long-term epidural pressure recording in hydrocephalic patients. The technique identifies those with episodically raised intracranial pressure. The effect of shunts on the pressure profile in these patients is described.
Distribution of activity in spinal pathways evoked by experimental dorsal column stimulation
Authors: Bantli Heinrich , Bloedel James R. , Long Donlin M. , Thienprasit Phudhiphorn
Published: May 2009

✓ Experiments were performed in rhesus monkeys to determine the distribution of activity evoked in spinal pathways by dorsal column stimulation. It was shown that many pathways in both the dorsal and ventral quadrants of the cord can be activated either directly or transsynaptically by stimulation with electrodes of the type implanted clinically. Moreover, the transsynaptically evoked responses recorded in each quadrant had somewhat different characteristics. Therefore, since the activation of each group of pathways may have differing effects in modifying the perception of noxious stimuli, the authors believe that changes in electrode position and stimulus parameters may be important in obtaining the therapeutic value of spinal cord stimulation for relief of pain.
Supraspinal interactions resulting from experimental dorsal column stimulation
Authors: Bantli Heinrich , Bloedel James R. , Thienprasit Phudhiphorn
Published: May 2009

✓ Experiments were performed on rhesus monkeys to examine the hypothesis that stimulation with dorsal column electrodes of the type implanted clinically could alter the responses evoked in supraspinal nuclei through pathways in the ventral quadrant of the spinal cord. Dorsal column stimulation did produce changes in responses evoked in supraspinal nuclei; this effect could not be ascribed to a conduction block in ascending pathways. These results suggest that the mechanism of action of the dorsal column stimulator need not be dependent on interactions in the dorsal horn.
Phantom limb pain
Authors: Nielson Karl D. , Adams John E. , Hosobuchi Yoshio
Published: May 2009

✓ Good to excellent relief of phantom pain is reported in 5 of 6 patients by the use of dorsal column stimulation. Follow-up periods are 7 to 25 months. One failure occurred despite excellent pain relief; this patient could not tolerate application of the DCS apparatus to his chest wall. The authors review the physiology involved and some less successful series reported by others.
Spontaneous intracerebral hematoma caused by cerebral neoplasms
Authors: Scott Michael
Published: May 2009

✓ In eight of 590 consecutive patients operated on by the author for a proven brain tumor, the preoperative diagnosis was complicated by a spontaneous intracerebral hematoma caused by the neoplasm. The presenting symptoms were those of hypertensive intracerebral hemorrhage or brain tumor. The pathology underlying spontaneous bleeding from a cerebral neoplasm is reviewed and diagnostic suggestions discussed.
Intracranial chordoma in infancy
Authors: Becker Laurence E. , Yates Allan J. , Hoffman Harold J. , Norman Margaret G.
Published: May 2009

✓ The authors describe a case in which a large clival chordoma became symptomatic in a 10-month-old infant, and was surgically excised and irradiated at 21 months. Two years later there is no evidence of recurrence.
Supratentorial neuroepithelial cysts
Authors: Palma Lucio
Published: May 2009

✓ Two cases of supratentorial neuroepithelial (ependymal) cysts, one parasagittal and the other located over the parietal convexity, are reported. Comparable reported cases are discussed and a theory of pathogenesis presented.
Rocking platform for paraplegic patients in wheel chairs
Authors: Jackson Frederick E. , Wojcik Victor F. , Wojcik Warren R.
Published: May 2009

✓ The authors have developed a rocking platform that can be used by a wheel-chair patient without additional aid to relieve constant pressure on the body and consequent skin breakdown.
Chymopapain treatment of intervertebral disc disease
Authors: Watts Clark , Knighton Robert , Roulhac George
Published: May 2009

✓ In the first of a two-part study, the authors review the known biochemical, pharmacological, toxicological, and experimental data concerning chymopapain and the intervertebral disc. They describe the action of this proteolytic enzyme, which apparently disrupts the protein mucopolysaccharide component of disc material, most marked in the nucleus pulposus. A rapid conversion to collagen causes a loss of disc space height; toxicity appears to result from alteration of bonding between capillary endothelial cells that in turn produces hemorrhage. Part 2 reviews significant reported results and complications of clinical chemonucleolysis.
Intervertebral bone implants following excision of protruded lumbar discs
Authors: Christoferson Lee A. , Selland Bradford
Published: May 2009

✓ The authors describe a technique whereby a portion of the lamina removed during exposure of an intervertebral lumbar disc protrusion is implanted in the intervertebral disc space following disc excision. An analysis of 456 consecutive cases operated on by this technique and followed from 1 to 10 years is presented. Of the 418 patients followed, 92% indicated they were able to return to their normal activities and were satisfied with the result. Thirty percent of the patients indicated they had required some conservative treatment for recurrent episodes of back or leg pain. Ten patients had subsequent back surgery; only one implant has dislocated.
Transverse axial tomography of the spine
Authors: Jacobson Robert E. , Gargano Fredie P. , Rosomoff Hubert L.
Published: May 2009

✓ The authors describe the diagnostic value of transverse axial tomography in developmental lumbar stenosis, spondylosis, facetal hypertrophy, and other abnormalities that can constrict the spinal canal.
Experimental cerebral vasospasm
Authors: Nagai Hajime , Noda Satoshi , Mabe Hideo
Published: May 2009

✓ The authors report the effects of vasoactive drugs and sympathectomy on experimental spasm using vertebral angiography. Papaverine and isoxsuprine injections into the vertebral artery released both early and late spasm. The antiserotonin agent, methysergide, and the alpha adrenergic blocking agent, phentolamine, released early but not late spasm. In sympathectomized dogs, early spasm was milder than in untreated dogs; however, late spasm was the same as in untreated dogs. The authors discuss an etiological difference between early and late spasm.
Treatment of postoperative cerebrospinal fluid fistulas by subarachnoid drainage
Authors: McCallum Jack , Maroon Joseph C. , Jannetta Peter J.
Published: May 2009

✓ The authors report the details of the successful treatment of 11 of 12 patients with postoperative cerebrospinal fluid fistulas. Continuous lumbar or ventricular fluid drainage was used.
Psychological improvement following arteriovenous malformation excision
Authors: Carter L. Philip , Morgan Michael , Urrea Donald
Published: May 2009

✓ A patient with a right frontal lobe arteriovenous malformation demonstrated progressive intellectual deterioration on neuropsychological tests. Following complete excision of the arteriovenous malformation, the patient's visuomotor function and visual recall were greatly improved, probably the result of elimination of arteriovenous shunts that were taking blood away from functional tissue.
Arteriovenous malformation of choroid plexus
Authors: Hodge Charles J. , King Robert B.
Published: May 2009

✓ The authors describe a patient with subarachnoid hemorrhage from an arteriovenous malformation of the choroid plexus and present a brief review of related reports.
Intramedullary neurilemoma of the cervical spinal cord
Authors: Wood William G. , Rothman Lewis M. , Nussbaum Berl E.
Published: May 2009

✓ A case of intramedullary neurilemoma of the cervical spinal cord is reported and a hypothesis for its origin discussed. The importance of pretreatment biopsy is emphasized.
Rupture of posterior inferior cerebellar artery aneurysm into the subarachnoid space during angiography
Authors: Gerlock Amil James
Published: May 2009

✓ The author reports a case of angiographically-demonstrated aneurysmal rupture, and reviews related reports.
Angiographic demonstration of congenital absence of both internal carotid arteries
Authors: Rosen Ivan W. , Mills Damon F. , Nadel Harold I. , Kaiserman Donald D.
Published: May 2009

✓ The authors present angiographic demonstration of bilateral, congenital, total absence of the internal carotid arteries in a patient with subarachnoid hemorrhage. Angiography demonstrated complete absence of both internal carotid arteries. The intracranial blood supply had been provided by communication between a hypertrophied basilar artery and the circle of Willis through the posterior communicating arteries. An aneurysm, believed to be the site of the subarachnoid hemorrhage, arose from the basilar artery. Absence of the carotid canals substantiated the congenital nature of the anomaly. The related embryology is reviewed.
Normal position of the aqueduct of Sylvius
Authors: Krogness Karl Guldberg
Published: May 2009

✓ The author describes a method for estimating the position of the aqueduct of Sylvius based on the ratio of the measured distance from surface to aqueduct (A) to that from the surface to dorsum sellae (B). The normal ratio A:B is 0.72 with a range from 0.68 to 0.75. Values below 0.68 indicate a dorsally displaced aqueduct.
Normal position of the aqueduct of Sylvius
Authors: Krogness Karl Guldberg
Published: May 2009

✓ Two new proportional methods for determination of the normal or abnormal position of the cerebral aqueduct are described. The position of the iter is expressed by the quotients and , when d-aq represents the distance between the upper posterior surface of the dorsum sellae and the dorsal center of the air-filled aqueduct. Ts = aq is the distance from the tuberculum sellae to the same point, and Tw is Twining's line. The normal value of the dorsum to aqueduct ratio was 0.32 ± 0.02 standard deviation (SD) and of the tuberculum to aqueduct ratio 0.44 ± 0.03 SD. Both proportional methods are independent of skull dimensions. These are compared to another proportional method described in Part 1 of this report.
Echoencephalographic A-scan study of the aqueduct and brain stem
Authors: Krogness Karl Guldberg
Published: May 2009

✓ The author utilizes autopsy models and normal clinical subjects with and without pneumoencephalography to demonstrate the value of echoencephalography in delineating the position of the aqueduct of Sylvius. Echoes from the dorsum sellae, the anterior wall of the sella turcica, and the aqueduct proved consistently identifiable, while echoencephalographic examination of 25 normal subjects revealed in all instances well-defined aqueduct echoes. Thus the aqueduct echo method may be a diagnostic aid in determination of the anterior-posterior position of the brain stem.
Selective sacral rootlet rhizotomy for hypertonic neurogenic bladder
Authors: Toczek Stanislaw K. , McCullough David C. , Gargour Guy W. , Kachman Rudolf , Baker Roger , Luessenhop Alfred J.
Published: May 2009

✓ The authors describe a highly selective transsacral microsurgical procedure for sacral nerve rootlet interruption in five patients with hypertonic neurogenic bladder. Magnification and systematic stimulation of sacral roots provided accurate identification of motor fibers supplying bladder detrusor muscle and differentiation of efferent components to the legs and anal sphincter. Although the technique prevented incontinence and adverse effects of nerve section on rectal and lower extremity function, improvement in voiding patterns and diminution of urinary sepsis was of brief duration in three of the five patients. Physiological data from these procedures reaffirms the importance of S-3 and S-4 motor roots in detrusor innervation, but clinical responses bring into question the possibility of sustained improvement from such a highly selective procedure at the sacral level. The authors suggest that alternative pathways, not apparent on initial stimulation, may develop after section of sacral root components, and that dissection and stimulation of fibers at the level of the conus medullaris should be investigated as an alternative procedure.
Cerebral mucormycosis following open head trauma
Authors: Ignelzi Ronald J. , VanderArk Gary D.
Published: May 2009

✓ The authors describe a case of human cerebral mucormycosis following open head trauma and craniotomy, and discuss possible roles of steroids and antibiotic therapy in its pathogenesis. They suggest that the common usage of prolonged broad-spectrum chemoprophylaxis in head trauma may require critical review.
Hydrocephalus resulting from superior vena cava thrombosis in an infant
Authors: Haar Floyd L. , Miller Carole A.
Published: May 2009

✓ The authors report an unusual case of superior vena cava thrombosis in an infant who subsequently developed communicating hydrocephalus; they also review previously reported cases of dural sinus hypertension, and separate them into two groups. Patients in the first group develop hydrocephalus and those in the second develop a pseudotumor-like syndrome. The former patients tend to have generalized increase in intracranial venous pressure while the latter have a normal pressure in some major intracranial venous structure(s). The absence of venous cushioning of the choroid plexus pulse wave is proposed as the cause of ventricular enlargement in the former group. In addition, patients in the large-ventricle group were younger than patients in the small-ventricle group.
Direct cardiac shunt for hydrocephalus of infancy and childhood
Authors: Milhorat Thomas H. , McClenathan James E.
Published: May 2009

✓ The authors describe a technique for direct cardiac shunting in which an adult-size ventriculoatrial catheter is coiled in an intrathoracic Silastic pouch and implanted in infants with hydrocephalus. In three patients so treated, serial chest films have shown progressive uncoiling of the catheter over a follow-up interval of 6 to 14 months.
Formation of cerebrospinal fluid
Authors: Pollay Michael
Published: May 2009

✓ After a brief summary of current views on the origin of cerebrospinal fluid (CSF) and the processes underlying its elaboration, the author discusses studies of isolated choroid plexus in extracorporeal perfusion systems and flux chambers. The results suggest that transependymal water flow is secondary to the electrically silent pumping of sodium. The author presents evidence in support of the standing gradient hypothesis as the structural basis of CSF secretion.
Cerebrospinal fluid formation in ventricles and spinal subarachnoid space of the rhesus monkey
Authors: Lux Warren E. , Fenstermacher Joseph D.
Published: May 2009

✓ The authors perfused rhesus monkeys from lateral ventricles to lumbar sac with an artificial cerebrospinal fluid (CSF) containing a Blue Dextran 2000 marker. Analysis of marker dilution at steady state showed ventricular CSF formation occurring at a rate of 28.3 ± 2.5 µ1/min. No significant CSF formation was found in the spinal subarachnoid space.
Follow-up analysis of ventriculoperitoneal and ventriculoatrial shunts for hydrocephalus
Authors: Ignelzi Ronald J. , Kirsch Wolff M.
Published: May 2009

✓ The authors report an analysis of 300 patients in whom primary treatment for hydrocephalus was either a ventriculoperitoneal (VP) or ventriculoatrial (VA) shunt. Although differences in primary and total revision rates between placements were not statistically significant, the VA shunt failures carried a higher morbidity than the VP placements.
Vasodilator system for the face
Authors: Gonzalez Guillermo , Onofrio Burton M. , Kerr Frederick W. L.
Published: May 2009

✓ The authors describe investigations in cats to delineate a vasodilator system to the face, which they undertook after a previous study showed that radiofrequency coagulation of the trigeminal ganglion produced a pronounced flush in the skin of the corresponding division. Results demonstrate a vasodilator system emerging from the brain stem with the facial nerve which, by way of the greater superficial petrosal nerve, reaches the trigeminal ganglion. There the fibers are distributed to each of the divisions of the fifth nerve; in addition, a moderate number of vasodilator fibers also appear to leave the brain stem directly with the trigeminal nerve. Vasodilator effects were elicited by stereotaxic stimulation of the facial and trigeminal nuclei in the brain stem. There is, therefore, a dual vasomotor control of the facial cutaneous vascular bed; the classical sympathetic vasoconstrictor system of the face is complemented by a vasodilator system capable of producing changes of equal but opposite amplitude in vessel caliber.
Pupillary sparing in oculomotor palsy from internal carotid aneurysm
Authors: Kasoff Ira , Kelly David L.
Published: May 2009

✓ The authors report a patient with a carotid-posterior communicating artery aneurysm; although the oculomotor palsy accompanying such an aneurysm is almost universally recognized as being complete, with pupillary involvement, this patient had pupillary sparing in the absence of subarachnoid bleeding. A few similar cases have appeared in the literature. The mechanism of pupillary sparing appears to be based on the position of the parasympathetic pupilloconstrictor fibers within the subarachnoid portion of the third nerve and on the anatomic relationship between the third nerve and the junction of the carotid and posterior communicating arteries.
Spontaneous elevation of a depressed skull fracture in an infant
Authors: Ross Gerald
Published: May 2009

✓ This is a report of an infant with a depressed skull fracture that apparently elevated spontaneously within a period of 4 hours.
Endotracheal intubation in patients with fractures of the cervical spine
Authors: Kapp John P.
Published: May 2009

✓ The author presents a safe method of endotracheal intubation for anesthesia without moving the neck in patients with fractures of the cervical spine.
Clinical, arteriographic, and cisternographic observations after removal of acute subdural hematoma
Authors: Hoff Julian , Grollmus John , Barnes Barbara , Margolis M. Theodore
Published: May 2009

✓ The authors review 47 patients with closed-head injuries requiring treatment for acute subdural hematoma and report that 21 (45%) survived for 5 days or more. Follow-up study of these 21 survivors led to the following observations: that clinical evaluation of these patients is the most reliable index of their postoperative progress; that the diagnostic usefulness of postoperative cerebral arteriograms is limited because immediate postoperative changes tend to persist; that craniotomy is preferable to burr holes for removal of an acute hematoma; and that the value of cisternography, unless done serially, is limited since posttraumatic hydrocephalus develops rapidly and may persist indefinitely.
Radiation of infratentorial and supratentorial brain-stem tumors
Authors: Lee Fransiska
Published: May 2009

✓ A retrospective survey of 41 patients with unbiopsied thalamic, pontine, and medullary tumors treated with radiation therapy demonstrated 30% to 40% 3-year survival, with seven long-term survivors. Eleven of the 12 patients surviving over 3 years have essentially normal neurological function. Of seven patients in whom histological diagnoses were eventually obtained, four proved to have glioblastomas and three low-grade astrocytomas. Autopsy revealed that all glioblastomatous tumors extended beyond the treatment field; this suggested that larger volumes, perhaps the whole brain, should be irradiated. High doses (at least 5000 rads) should be used since the 3-year survival among those receiving such doses was 45%.
Neuroepithelial (colloid) cysts of the septum pellucidum
Authors: Ciric Ivan , Zivin Israel
Published: May 2009

✓ The authors present two cases of neuroepithelial (colloid) cysts found above the diencephalic roof, occupying the space between the two fornices and the two leaves of the septum pellucidum, and describe the clinical history, neurological, and neuroradiological findings. Both lesions were removed through a right transventricular-transseptal approach. No other report of such a lesion in this location could be found in the review of literature. The pathogenesis of these cysts, both above and below the diencephalic roof, is discussed in light of the developmental anatomy of the area under consideration. In view of their origin from the neuroepithelium in the diencephalic roof, whether by a process of invagination into the third ventricle or by evagination into the velum interpositum, the so-called colloid cysts are more appropriately termed neuroepithelial cysts.
Intracerebellar “ fibroma”
Authors: Llena Josefina F. , Chung Hyung D. , Hirano Asao , Feiring Emmanuel H. , Zimmerman Harry M.
Published: May 2009

✓ The authors report a unique case of intracerebellar fibroma; the tumor was well circumscribed and was treated by complete excision.
Concurrent intracranial and spinal cord arteriovenous malformations
Authors: Hash Cecil J. , Grossman Charles B. , Shenkin Henry A.
Published: May 2009

✓ The authors report the case of a patient with subarachnoid hemorrhage in whom an intracranial dural arteriovenous malformation coexisted with a spinal arteriovenous malformation. The latter was considered to be the source of the hemorrhage by clinical and radiographic criteria. It is concluded that patients with subarachnoid hemorrhage who show no suitable intracranial source for their bleed in some instances should be investigated for a spinal origin of hemorrhage.
Blood flow in normal and injured monkey spinal cord
Authors: Bingham W. George , Goldman Harold , Friedman Stewart J. , Murphy Sharon , Yashon David , Hunt William E.
Published: May 2009

✓ The authors used indicator fractionation techniques to determine blood flow in normal and bluntly traumatized spinal cords of Macaca rhesus monkeys. Normal flow rates were determined for several levels of spinal cord as well as differential values for white and gray matter from representative areas. Flow rates in traumatized tissue, obtained at several different time intervals up to 4 hours after injury, demonstrated marked differences in regional perfusion of the white matter and gray matter after trauma. Gray matter perfusion was nearly obliterated while white matter blood flow persisted and in fact was higher than uninjured controls. The findings do not support the concept of ischemia as a factor in white matter failure. If toxic pathobiochemical alterations are induced by trauma, it may be possible to reverse these changes by exploiting the preserved white matter blood flow for chemotherapeutic intervention.
Central functional changes after facial-spinal-accessory anastomosis in man and facial-hypoglossal anastomosis in the cat
Authors: Vera Cristian L. , Lewin Marcial G. , Kase Juan C. , Calderon Mara D. T.
Published: May 2009

✓ A left facial-spinal-accessory anastomosis was performed for peripheral facial paralysis in an 8-year-old boy. By the fourth postoperative year, the corneal reflex showed a normal latency, and left arm and face movements could be executed independently. The possibility of neural plasticity playing a role in establishing new central relationships which enable the achievement of a “normal” latency corneal reflex and independent face and arm movements is discussed.

The latency of the corneal reflex recorded as electrical response of the orbicularis oculi muscle to electrical stimulation of the ipsilateral cornea was measured in normal cats and in cats which had undergone a facial-hypoglossal anastomosis 12 to 14 months previously. The latency of the reflex was 8 to 22 msec in normal animals and 200 to 300 msec in the operated cats, while conduction times in the regenerated hypoglossal nerve fibers were found to be within normal limits. This suggests that the long latency of the corneal reflex following the cross anastomosis is due to the time required for transmission across newly-formed connections between the trigeminal terminals and the hypoglossal neurons.
Aspergillosis of the fourth ventricle
Authors: Correa Amilcar J. E. , Brinckhaus Raul , Kesler Saul , Martinez Eugenio
Published: May 2009

✓ The authors present a case of Aspergillus infection of the brain; this is believed to be the second case of its kind in Argentina, and probably the only reported case involving an intracranial mycetoma.
Deficiency of gonadotropin-releasing factor in a patient with hydrocephalus internus
Authors: Coenegracht Joseph M. , Bie Jan P. A. M.de , Coene Louis N. M. , Padberg George
Published: May 2009

✓ The authors present the case of a 21-year-old woman with primary amenorrhea and hydrocephalus internus, and suggest that the amenorrhea was probably caused by insufficient basal and cyclic activity of luteinizing hormone/releasing hormone-producing neurons in the hypothalamus. The amenorrhea persisted after ventriculocisternotomy; only after several therapeutic trials with estrogens and progesteron did spontaneous menstrual periods appear more than 5 years after operation.
Ligation of the vertebral (unilateral or bilateral) or basilar artery in the treatment of large intracranial aneurysms
Authors: Drake Charles G.
Published: May 2009

✓ The author reports the use of vertebral artery ligation, unilateral and bilateral, for the treatment of large vertebral-basilar aneurysms in 14 patients with one delayed death. Extracranial ligation was carried out unilaterally with a Selverstone clamp in three patients. In two, where the aneurysm filled only from one vertebral artery, there was extensive thrombosis within the sac and dramatic clinical improvement after decompression. Extracranial ligation was done bilaterally in three patients, temporarily in two. A 14-year-old boy is well after 5 years but the bilateral vertebrobasilar aneurysm did not undergo extensive thrombosis until both vertebral arteries were occluded at their intracranial entrance above collateral flow. In two others, the clamp had to be reopened on the second artery. In one patient, death from delayed thrombosis of a huge aneurysm and pontine infarction might have been prevented with anticoagulants. In the other, the aneurysm ruptured again fatally 18 months later.

Unilateral intracranial occlusion of a vertebral artery was done in eight cases, with no morbidity and complete or nearly complete thrombosis in all but one aneurysm. Seven patients had excellent or good results while one showed little recovery from an existing medullary syndrome.

Occlusion of the basilar artery was done in seven cases. In five it was used deliberately as the only treatment, but in two it was forced when an aneurysm burst during dissection. Only two of the patients in the first group and one of the second group have made complete recoveries.

The results of vertebral artery occlusion are encouraging and the technique deserves further consideration. Extensive collateral circulation enhances the safety of cervical vertebral artery occlusion but can be of a degree to make the occlusion ineffective. For intracranial occlusion knowledge of the size and distribution of each vertebral artery is essential. Occlusion of the basilar artery is dangerous, although it seems to be effective in producing extensive thrombosis in the aneurysm. It should probably be done under anesthesia only when the artery fills spontaneously from the carotid circulation. Otherwise, even when reasonable posterior communicating arteries are demonstrated, it is best to test occlusion under local anesthesia.
Microsurgical anatomy of the sellar region
Authors: Renn Wade H. , Rhoton Albert L.
Published: May 2009

✓ Fifty adult sellae and surrounding structures were examined under magnification with special attention given to anatomical variants important to the transfrontal and transsphenoidal surgical approaches. The discovered variants considered disadvantageous to the transsphenoidal approach were as follows: 1) large anterior intercavernous sinuses extending anterior to the gland just posterior to the anterior sellar wall in 10%; 2) a thin diaphragm in 62%, or a diaphragm with a large opening in 56%; 3) carotid arteries exposed in the sphenoid sinus with no bone over them in 4%; 4) carotid arteries that approach within 4 mm of midline within the sella in 10%; 5) optic canals with bone defects exposing the optic nerves in the sphenoid sinus in 4%; 6) a thick sellar floor in 18%; 7) sphenoid sinuses with no major septum in 28% or a sinus with the major septum well off midline in 47%; and 8) a presellar type of sphenoid sinus with no obvious bulge of the sellar floor into the sphenoid sinus in 20%.

Variants considered disadvantageous to the transfrontal approach were found as follows: 1) a prefixed chiasm in 10% and a normal chiasm with 2 mm or less between the chiasm and tuberculum sellae in 14%; 2) an acute angle between the optic nerves as they entered the chiasm in 25%; 3) a prominent tuberculum sella protruding above a line connecting the optic nerves as they entered the optic canals in 44%; and 4) carotid arteries approaching within 4 mm of midline within or above the sella turcica in 12%.
Anterior transthoracic surgical decompression of acute spinal cord injuries
Authors: Paul Ronald L. , Michael Roger H. , Dunn James E. , Williams J. Powell
Published: May 2009

✓ Three cases of incomplete acute traumatic myelopathies resulting from anterior spinal cord compression were managed by direct surgical decompression by way of the transthoracic approach. The surgical anatomy, technique, diagnostic work-up, and indications for the procedure are discussed.
Experimental cerebral oligemia and ischemia produced by intracranial hypertension
Authors: Marshall Lawrence F. , Graham David I. , Durity Felix , Lounsbury Robert , Welsh Frank , Langfitt Thomas W.
Published: May 2009

✓ The authors studied the morphological sequelae of 15 minutes of cerebral oligemia (20 torr cerebral perfusion pressure) and complete cerebral ischemia produced by raised intracranial pressure in rabbits. Ischemic cell change was present in five of seven ischemic animals; it was most extensive in the striatum and hippocampus, with only a few ischemic nerve cells in the thalamus and neocortex. The brains of control and oligemic animals were normal. These results indicate the following: 1) ischemia is a more severe insult than oligemia; 2) compression ischemia results in a pattern of damage that differs from that produced by other types of ischemia; and 3) the method used to reduce cerebral perfusion pressure is an important factor in determining the pattern and extent of brain damage produced.
Suprascapular entrapment neuropathy
Authors: Clein Lawrence J.
Published: May 2009

✓ The author describes the syndrome of suprascapular nerve entrapment neuropathy that occurs as that nerve passes beneath the transverse scapular ligament, and discusses the anatomy, comparative anatomy, and five case histories. The cardinal findings include pain in the shoulder, weakness, and wasting of spinati muscles, and a positive electromyogram. Treatment is by division of the transverse scapular ligament.
Successful surgical treatment of bilateral carotid-cavernous fistulas
Authors: Conley Frances K. , Hamilton Richard D. , Hosobuchi Yoshio
Published: May 2009

✓ The authors report a case of traumatic bilateral carotid-cavernous sinus fistulas, successfully treated by surgical electrothrombosis of both cavernous sinuses.
Diagnosis and treatment of diffuse intravascular coagulation following cerebral trauma
Authors: McGauley James L. , Miller Carole A. , Penner John A.
Published: May 2009

✓ The authors report the development of diffuse intravascular coagulation following massive cerebral trauma in a child. The importance of anticipating this complication is stressed and recommendations for early diagnosis and treatment are presented.
Management of ischemic complications after subarachnoid hemorrhage
Authors: Sundt Thoralf M.
Published: May 2009

✓ The author reviews a form of management for patients deteriorating preoperatively or postoperatively from apparent ischemia attributed to progressive vasospasm after a subarachnoid hemorrhage. The clinical picture and relative frequency of this complication are considered in relationship to the status (grade) of the patient, location of the aneurysm, and ultimate neurological recovery. Experience suggests that the drug regimen reported is useful when instituted early after the onset of symptoms and is safe with proper monitoring techniques. The data do not justify early operative intervention after a subarachnoid hemorrhage, operation when there is angiographic evidence of severe spasm, or expectation of a dramatic effect in patients with a profound deficit or a fixed deficit several hours old.
Pituitary adenomas of adolescents
Authors: Ortiz-Suarez Humberto , Erickson Donald L.
Published: May 2009

✓ A review of four cases of chromophobe adenomas in adolescents suggests that extracapsular extension with invasion of parasellar structures is more common in this age group than in adults. A syndrome of adolescent obesity, oculomotor palsies, and plain x-ray changes of the sella characterizes this group.
Percutaneous trial of stimulation for patient selection for implantable stimulating devices
Authors: Erickson Donald L.
Published: May 2009

✓ The author describes a flexible electrode which can be inserted percutaneously for a period of several days in candidates for an implantable electrical stimulating device for pain relief. This allows the patient a trial of stimulation which closely mimics that of the intended implantable system. If this trial does not give adequate pain relief in a variety of situations, the patient is not considered to be a suitable candidate for an implantable device. The trial of stimulation in no way obviates the need for careful scrutiny of the social and psychological factors accompanying chronic pain problems.
Percutaneous radiofrequency denervation of spinal facets
Authors: Shealy C. Norman
Published: May 2009

✓ A technique for radiofrequency localization and coagulation of articular nerves supplying the spinal facets is described and results are reported from a series of 207 patients followed 6 to 21 months (mean 13 months). Relief of pain was achieved in 79% of previously unoperated patients, in 41% of those with laminectomy but no fusion, and in 27% of those with an earlier fusion. No neurological complications were encountered.
Meningomyelocele and progressive hydromyelia
Authors: Hall Peter V. , Campbell Robert L. , Kalsbeck John E.
Published: May 2009

✓ Five cases of myelodysplasia with progressive paraparesis are presented. Three of the five patients developed spasticity, but dissociated sensory loss and loss of sphincter control was not a prominent feature. All were found to have compensated hydrocephalus and extensive communicating hydromyelia. The use of myelography and ventriculography in the diagnosis of hydromyelia is discussed. Ventricular drainage led to clinical improvement in two cases and radiological improvement in one. The relationship of compensated hydrocephalus, meningomyelocele, and progressive hydromyelia postnatally may support the hydrodynamic hypothesis of myelodysplasia.
Evaluation of postcraniotomy patients by radionuclide scan
Authors: Waxman Alan D. , Siemsen Jan K. , Wolfstein Ralph S. , Kurze Theodore
Published: May 2009

✓ Twenty-eight patients with cerebral tumors were evaluated after craniotomy with combined radionuclide techniques in order to assess presence or absence of tumor recurrence. The combination of a positive pertechnetate or Tc-phosphate scan with a positive gallium scan strongly indicates the presence of recurrent or residual tumor. Infection may also cause uptake but was easily distinguished by the distribution. Negative gallium scans with positive technetium scans were indicative of non-recurrence in this series.
Spinal cord compression by extramedullary hemopoietic tissue in sickle cell anemia
Authors: Ammoumi Abdel A. , Sher Joanna H. , Schmelka Daniel
Published: May 2009

✓ The authors report a patient with sickle cell anemia who suffered from paraplegia of 18 months duration due to spinal cord compression by a hemopoietic mass. Recovery following removal of the mass was complete.
Automatically irrigated bipolar forceps
Authors: Dujovny Manuel , Vas Ran , Osgood Carroll P. , Maroon Joseph C. , Janetta Peter J.
Published: May 2009

✓ The authors describe a newly developed automatically irrigated bipolar forceps with controlled irrigation pressure.
Modified disc rongeur
Authors: Lake Peter A.
Published: May 2009

✓ The author presents a modification of a standard pituitary rongeur, designed to avoid instrument penetration into the abdominal cavity during lumbar disc surgery.
Our underpinnings: a bicentennial view
Authors: McCracken Paul W.
Published: May 2009

✓ The author describes the emergence of the liberal tradition which is the foundation of the political and economic systems in this country and considers policies that may affect our social and economic future.
Compartmental analysis of compliance and outflow resistance of the cerebrospinal fluid system
Authors: Marmarou Anthony , Shulman Kenneth , LaMorgese James
Published: May 2009

✓ The distribution of compliance and outflow resistance between cerebral and spinal compartments was measured in anesthetized, ventilated cats by analysis of the cerebrospinal fluid (CSF) pressure response to changes in CSF volume. Cerebral and spinal compartments were isolated by inflating a balloon positioned epidurally at the level of C-6. The change of CSF volume per unit change in pressure (compliance) and change of CSF volume per unit of time (absorption) were evaluated by inserting pressure data from the experimental responses into a series of equations developed from a mathematical model. It was found that 68% of total compliance is contributed by the cerebral compartment while the remaining 32% is contained within the spinal axis. The cerebral compartment accounted for 84% of total CSF absorption. The mechanism for spinal absorption appears to be similar in that no differences were obvious on the basis of pressure dynamics.
Micro- and macrovascular changes as the direct cause of parenchymal destruction in congenital murine hydrocephalus
Authors: Wozniak Maciej , McLone David G. , Raimondi Anthony J.
Published: May 2009

✓ Microangiotomography was used to identify the normal and pathological pattern of cerebral vessels in the hy-3 murine mutant mouse (normal and hydrocephalic) at various developmental stages from birth through 21 days of life. The technique employed allows resolution, in the range of 7 to 10 µ of the surface and in-traparenchymal (perforating) microvasculature. Ventricular enlargement causes displacement of primary cerebral arteries, followed by both stretching and a decrease in the caliber of primary, secondary, and tertiary vessels (arterial and venous). Ultimately, there is a reduction in the number and caliber of the microvasculature, resulting in diminished cerebral blood flow and cerebral edema. Tissue destruction leading to ependymal rupture, parenchymal cavitation, and the formation of porencephalic cysts within the edematous parenchyma ensues.

External ventricular drainage, by decompressing the ventricles, resulted in rapid restoration of the filling of the primary and secondary vessels, thereby suggesting the primary role of vascular changes in the production of brain damage. This study offers experimental evidence that early diversion of the cerebrospinal fluid interrupts this chain of events in congenital murine hydrocephalus.
Anatomical mapping of the cerebral nervi vasorum in the human brain
Authors: Sato So , Suzuki Jiro
Published: May 2009

✓ The authors present an anatomical study of the vascular nerve fiber distribution to the human intracranial arteries. These fibers are abundant in the circle of Willis and its neighboring arteries, but there are no vascular nerves in small pial arteries over the convexity. These nerve fibers are provided with a cluster of synaptic vesicles as they approach the smooth muscle cells of the media. Adrenergic axons are also found in these fibers.
Systemic hypotension in neurosurgery
Authors: Yashon David , Magness Alfred P. , Vise W. Michael
Published: May 2009

✓ The authors review the intraoperative use of elective hypotension to reduce the probability of hemorrhage, to increase pliability of the aneurysmal sac for ease of clip application, and to control hemorrhage. The optimum agent and techniques for lowering systemic blood pressure remain controversial, but trimethaphan, sodium nitroprusside, and halothane have been found most useful. When cerebral blood flow falls below the brain's capacity to autoregulate, distinct time-related alterations occur biochemically and histologically. The profile of prolonged reduced adenosine triphosphate (ATP), low phosphocreatine, low glucose, and elevated lactate and lactate/pyruvate ratio is associated with swelling of perivascular astrocytes and “blebbing” of vascular endothelial cells with subsequent cerebral damage. To prevent permanent alteration it is desirable to observe time constraints and to employ other means of protection such as hypothermia, although the authors believe the latter unnecessary for short hypotensive periods. It has been proposed, but not substantiated, that anesthetics which depress rate of cerebral oxygen consumption but do not affect cerebral ATP level protect the brain from hypotension. Several investigations suggest that halothane, a vasodiltor, satisfies the safety requirement. The most prominent contraindication to halothane, however, is elevation of intracranial pressure. At present hypotensive surgery for aneurysmorrhaphy is usually performed when intracranial pressure has returned to normal. Experimentally the electroencephalogram has been observed to show alterations prior to biochemical parameters for following brain vulnerability, so that it conceivably could be an effective monitoring technique during prolonged profound hypotension.
Temporal-lobe seizures with additional foci treated by resection
Authors: Buren John M. Van , Marsan Cosimo Ajmone , Mutsuga Naomi
Published: May 2009

✓ The authors describe the use of temporal lobectomy following careful and repeated electroencephalogram (EEG) evaluation (with implanted electrodes in otherwise unresolvable cases) in the epileptic group characterized by automatisms (psychomotor seizures) with temporal epileptiform activity complicated by EEG foci in the opposite temporal lobe or by extratemporal activity. They found that this can render a significant number of patients (between 25% and 50%) either seizure-free or with significant and useful reduction in their seizure frequency. The cure and improvement rates of cases followed up after temporal resection with or without prior study with implanted electrodes were approximately equal. However, the implanted electrodes permitted surgical treatment of certain cases which would have been rejected on the basis of evidence derived from the scalp recordings alone.

Of 28 of these 34 patients with persisting EEG epileptiform activity in the postoperative period, only one had such activity in a different location in a follow-up period of 6 years. No evidence of spreading epileptic activity or appearance of “mirror foci” was seen during a follow-up period averaging 8.2 years. Seizure remission up to 15 years with eventual recurrence of the original seizure type may occur following surgical therapy. Follow-up studies of surgical epileptic treatment of less than 3 to 5 years are of doubtful value.
Intrathalamic epidermoid tumor
Authors: Chandler William F. , Farhat Saeed M. , Pauli Francis J.
Published: May 2009

✓ A case of an intrathalamic epidermoid tumor is reported, and the literature is reviewed with regard to the incidence, location, and etiology of intracerebral epidermoid tumors. The high frequency of mental symptoms associated with these tumors is also discussed.
The “future trends” in neurosurgery are here
Authors: Schneider Richard C.
Published: May 2009

✓ The President of The American Association of Neurological Surgeons discusses the three major problems of his year in office — medical education, neurosurgical manpower, and professional medical liability — and the attempts that are being made to solve them.
Cerebral hemorrhage following heart surgery
Authors: Humphreys Robin P. , Hoffman Harold J. , Mustard William T. , Trusler George A.
Published: May 2009

✓ The authors report a study of the problem of intracranial hemorrhage in 16 children following cardiac surgery, four studied clinically, and 12 by postmortem pathological review. Eleven children sustained subdural hematomas of varying sizes, one had a massive extradural clot, and four had intracerebral clots. The pre-, intra-, and postoperative data of these 16 patients are presented, but the specific factors causing the intracranial hemorrhage remain unexplained. The neurological course was similar to that of patients with an intracranial space-occupying lesion, and fundamental neurosurgical management principles for the treatment of this potentially reversible process should be observed.