bluuebunny/crossref_metadata_2025 huggingface dataset:
Carotid cavernous fistula: direct repair with preservation of the carotid artery
Authors: Parkinson Dwight
Published: May 2009

✓ The techniques and advantages of the direct approach to carotid cavernous fistulas with repair of the fistula and preservation of the carotid artery are discussed with illustrative case reports. The surgical significance of the anatomy of the parasellar venous structures and their relationship to the carotid artery are discussed. Two points emphasized are that it is possible to operate within the cavernous sinus and still be outside both the venous and arterial components of the fistula, and that, by one means or another, the carotid should be preserved.
Closure of carotid-cavernous fistula with polyurethane foam embolus
Authors: Ohta Tomio , Nishimura Shuro , Kikuchi Haruhiko , Toyama Mitsuo
Published: May 2009

✓ This report describes a traumatic carotid-cavernous fistula treated by embolization with a newly developed polyurethane foam attached to 5—0 monofilament suture thread by a technique which does not necessitate either craniotomy or occlusion of the carotid artery in the neck. Carotid angiography 3 weeks after surgery showed satisfactory closure of the fistula and normal intracranial circulation from the involved carotid artery.
Carotid-cavernous fistula: a controlled embolus technique for occlusion of fistula with preservation of carotid blood flow
Authors: Black Perry , Uematsu Sumio , Perovic Milos , Walker A. Earl
Published: May 2009

✓ A case is described in which a carotid-cavernous fistula was eliminated successfully with preservation of the carotid circulation by a small ball-shaped muscle embolus introduced via an arteriotomy in the cervical carotid. The intent is to lodge the embolus in the fistula without occluding the carotid siphon. A long thread is attached to the embolus to permit its withdrawal if its position in the siphon proves unsatisfactory. Neither the intracranial nor cervical carotid artery is ligated.
Microvascular surgery: simplified instrumentation
Authors: Maroon Joseph C. , Roberts Esther , Numoto Mitsuo , Donaghy R. M. Peardon
Published: May 2009

✓ The essential instruments required for performing microvascular surgery are described, as well as how to construct them oneself. These include ligature carriers, microhooks, microdissectors, microtourniquets, and various types of suction devices.
Relation of prophylactic medication to the occurrence of early seizures following craniocerebral trauma
Authors: Rish Berrley L. , Caveness William F.
Published: May 2009

✓ In a series of 1614 cases of combat head injury incurred in Vietnam between 1967 and 1970, 70% received prophylatic anticonvulsant medication (diphenylhydantoin, 300 to 400 mg/day); 36 developed fits in the first week following injury. The prophylactic regimen had no recognizable effect. Therapeutic serum levels of anticonvulsants are not achieved for 2 or 3 weeks. Usefulness of dexamethasone in controlling brain swelling may be seriously impaired by diphenylhydantoin. Thus prophylaxis against early posttraumatic fits may not be practical or desirable.
Effect of Pantopaque myelography on cerebrospinal fluid fractions
Authors: Ferry Darwin J. , Gooding Ronald , Standefer Jim C. , Wiese G. Michael
Published: May 2009

✓ Cerebrospinal fluid (CSF) changes induced by Pantopaque myelography were determined by comparing samples of CSF from 47 patients with disc symptoms, obtained before and after myelography. Cell count, total protein, colloidal gold curve, and CSF protein electrophoretic patterns were compared. An immediate and persistent modest lymphocytosis was found. Total protein and CSF gamma globulin were elevated 3 weeks after myelography and throughout the remainder of the 80-day study period. This CSF profile characterizes a chronic inflammatory reaction induced by Pantopaque.
Experimental cerebral revascularization with autogenous grafts
Authors: Maroon Joseph C. , Donaghy R. M. Peardon
Published: May 2009

✓ Autogenous saphenous arterial or venous grafts were anastomosed between the commond carotid and the middle cerebral artery in 14 dogs with the aid of microsuturing techniques and a new type of microtourniquet. Four of the six saphenous artery grafts were patent when studied angiographically 4 to 70 days postoperatively. Three of the eight venous grafts were patent when studied 1, 3, and 18 days following surgery. The patency rate with arterial grafts was better than that with venous grafts because of the ease of handling due to the thicker wall, the reduced tendency toward redundancy and kinking, and the better graft-to-host-artery ratio. Obvious technical factors were found that accounted for all graft failures. Faulty suture placement; failure to remove an elliptical segment of the host artery; twisting, angulation and kinking of vein grafts; intimal flaps or adventitia caught in the suture line; and cerebral laceration and subsequent infarction were all causes of failure. Successful cerebral revascularization occurred only when these technical factors were surmounted and a satisfactory graft-to-host-artery ratio obtained.
Effect of skull rotation on x-ray evidence of displaced midline structures
Authors: Rayport Mark , Rayport Stephen G.
Published: May 2009

✓ During the initial urgent management of patients with acute brain lesions, skull roentgenograms or cerebral angiograms often result in rotated views. The classical method of maximum transverse measurement for the diagnosis of lateral displacement of the opacified pineal gland or great vein of Galen retains its validity in eight of 10 anteroposterior cranial roentgenograms rotated 8° and in nine of 10 rotated 5°. The explanation is expressed by the “circle in the skull” hypothesis which indicates that those portions of the lateral cranial wall whose projections serve as referential points for the maximum transverse measurement, form arcs of a circle of which the radius is the pineoparietal distance. The concept of the midsagittal arch of the skull is introduced as a method of cranial midline determination on rotated anteroposterior skull roentogenograms. This method gives dependable indication of significant shift of the opacified pineal gland and deep cerebral veins according to the criteria described.
Anastomotic connections between the eleventh nerve and the posterior root of the first cervical nerve in humans
Authors: Ouaknine G. , Nathan H.
Published: May 2009

✓ A study of connections between C-1, C-2, and the spinal accessory nerve is reported. Four variations are described from anatomical and clinical points of view. Often the only pathway for the sensory fibers of C-1 to reach the spinal cord is through the rootlets of the eleventh cranial nerve.
Surgical treatment of brain abscess and subdural empyema
Authors: Le Beau J. , Creissard P. , Harispe L. , Redondo A.
Published: May 2009

✓ Analysis of a personal series of 274 cases of brain abscess indicates that excision gives better results than aspiration, even in most of the so-called acute abscesses. The general outlines of the neurosurgical treatment are given, with emphasis on emergency procedures. A similar method is advised in cases of acute subdural empyema.
Primary neuroblastoma of the central nervous system with spontaneous extracranial metastases
Authors: Henriquez Antonio S. , Robertson David M. , Marshall W. John S.
Published: May 2009

✓ A case of spontaneous extracranial metastases from a cerebral neuroblastoma in the absence of prior surgery is reported. The tumor was discovered incidently through biopsy of an enlarged retro-auricular lymph node in an apparently well 7-year-old boy who had not previously received surgery or radiotherapy. The patient died 15 months later. Autopsy excluded neuroblastoma of the adrenal glands or the sympathetic chains.
Sagittal sinus repair
Authors: Peardon Donaghy R. M. , Wallman Lester J. , Flanagan Martin J. , Numoto Mitsuo
Published: May 2009

✓ A technique for reconstructing a venous dural sinus lacerated beyond the point of simple patching is described. The procedure involves immediate implantation of a vascular T-tube which is later replaced by an intima-lined stent. The method makes possible sinography and aspiration of clots, and a rapid replacement of continuity of blood flow.
Intracranial hemorrhage in children and adolescents
Authors: Sedzimir Carol B. , Robinson Julian
Published: May 2009

✓ The authors report their experience with 124 cases of intracranial hemorrhage in children and adolescents; the study includes 25 cases first reported in 1958. Fifty aneurysms with a mortality rate of 28% and 33 arteriovenous malformations with a mortality rate of 21% are included; 32 cases had no angiographically demonstrable lesion, six had miscellaneous lesions, and three primary cerebral hemorrhage. Specific programs for therapeutic management based on this experience are discussed.
Stimulation-mapping of the upper human auditory pathway
Authors: Tasker Ronald R. , Organ L. W.
Published: May 2009

✓ Auditory hallucinations were produced by electrical stimulation of the human upper brain stem during stereotaxic operations. The responses were confined to stimulation of the inferior colliculus, brachium of the inferior colliculus, medial geniculate body, and auditory radiations. Anatomical confirmation of an auditory site was obtained in one patient. The hallucination produced was a low-pitched nonspecific auditory “paresthesia” independent of the structure stimulated, the conditions of stimulation, or sonotopic factors. The effect was identical to that reported from stimulating the primary auditory cortex, and virtually all responses were contralateral. These observations have led to the following generalizations concerning electrical stimulation of the somesthetic, auditory, vestibular, and visual pathways within the human brain stem: the hallucination induced in each is the response to comparable conditions of stimulation, is nonspecific, independent of stimulation site, confined to the primary pathway concerned, chiefly contralateral, and identical to that induced by stimulating the corresponding primary auditory cortex. No sensory responses are found in the brain stem corresponding to those from the sensory association cortex.
Evoked cortical potentials in experimental spinal cord trauma
Authors: D'Angelo Charles M. , VanGilder John C. , Taub Arthur
Published: May 2009

✓ The somatosensory cortical evoked response following tibial nerve stimulation was recorded for 4 hours in cats sustaining 100, 300, and 500 gm-cm impact injuries to the posterior thoracic, posterior cervical, and anterior cervical spinal cord. The return of the evoked response could be correlated with the severity of pathological damage to the spinal cord. The evoked potential returned almost immediately in animals sustaining only gray matter petechial hemorrhages, was delayed until 1 hour in animals with perigray white matter hemorrhages, and did not return at all in animals with central cavitation and posterior column fragmentation.
Thromboembolism and brain tumors
Authors: Brisman Ronald , Mendell Jerry
Published: May 2009

✓ The relationship between brain tumor location and thromboembolism was studied by a retrospective review of autopsy and clinical material. Patients with suprasellar tumors had a higher incidence of thromboembolic complications than those with tumors in other locations. An associated derangement of hypothalamic function is suggested as predisposing to thromboembolism.
Dimethyl sulfoxide in the treatment of experimental brain compression
Authors: de la Torre J. C. , Rowed D. W. , Kawanaga H. M. , Mullan S.
Published: May 2009

✓ Forty rhesus monkeys were subjected to acute experimental head injury by extradural balloon compression of the brain. A critical endpoint in the compression was used to inject either saline, urea, or dimethyl sulfoxide (DMSO). All saline-treated animals died. Ten of 15 urea-treated animals survived, while 14 of 15 DMSO-injected monkeys survived. The incidence of neurological deficits seen in survivors was four for urea and one for DMSO. It is concluded that DMSO is capable of modifying the mortality rate and posttraumatic sequelae of brain injury in the experimental model used.
Intramedullary spinal abscess following spinal puncture
Authors: Rifaat Mohamed , El-Shafei Ismail , Samra Khairy , Sorour Osman
Published: May 2009

✓ A case is presented in which an intramedullary abscess of the spinal cord resulted from a high spinal puncture. Laminectomy and drainage were followed by complete cure.
Surgical treatment of irreducible atlanto-axial dislocation with spinal cord compression
Authors: Nagashima Chikao
Published: May 2009

✓ The author reports the successful treatment of a case of irreducile atlantoaxial dislocation due to separation of the dens and secondary arthritic changes causing sagittal narrowing of the atlanto-axial spinal canal to 3 mm. Complete myelography obstruction was present. A one-stage posterior decompression of the foramen magnum and atlas was performed and occipito-cervical fixation accomplished by wire encased in acrylic plastic.
Experiences with a translabyrinthine-transtentorial approach to the cerebellopontine angle
Authors: Morrison A. W. , King T. T.
Published: May 2009

✓ The technique, results, advantages, and complications of a combined translabyrinthine-transtentorial approach to the cerebellopontine angle are discussed. The method has been associated with a low morbidity and no operative mortality in 23 cases of acoustic nerve tumor and six with miscellaneous lesions.
Sural nerve biopsy
Authors: Asbury Arthur K. , Connolly Edward S.
Published: May 2009

✓ The uses and operative technique for sural nerve biopsy are described.
Electron microscopic study of ATPase activity in human brain tumors
Authors: Nakamura Saburo , Miyagami Mitsusuke , Moriyasu Nobuo
Published: May 2009

✓ Ultrastructural localization of ATPase was demonstrated in 15 human brain tumors; ATPase activity in the tumor cell was outside the cell membrane and appeared in varying degrees according to the type of tumor. Nonglial tumors such as meningiomas and chromophobe pituitary adenomas showed more intense enzyme activity than gliomas; malignant tumors such as medulloblastoma and glioblastoma multiforme showed low activity. Blood vessels in the tumor showed poor ATPase activity in both endothelium and basement membrane; the lack of ATPase in the vascular wall may contribute to the breakdown of the blood-brain barrier.
Stereotaxic diagnosis and treatment of intracranial tumors including an initial experience with cryosurgery for pinealomas
Authors: Conway Louis W.
Published: May 2009

✓ With use of the Todd-Wells stereotaxic unit and appropriate biopsy needles, confirmation was obtained of the preoperative diagnosis in 25 of 31 deep-seated intracranial tumors. Selective criteria, preoperative evaluation, and the method of biopsy are described, and the advantages of stereotaxic biopsy discussed. The successful addition of stereotaxic cryosurgical treatment of two pinealomas following biopsy is briefly reported.
The effect of mannitol on cerebral blood flow
Authors: Johnston Ian H. , Harper A. M.
Published: May 2009

✓ The effect of mannitol on cerebral blood flow was studied in anesthetized baboons, both at normal and raised intracranial pressure. At normal intracranial pressure, rapid intravenous infusion of mannitol (1.5 gm/kg in 10 min) led to a sharp transient rise in cerebral blood flow during and immediately after the period of infusion. This was associated with a reduction in cerebrovascular resistance and a variable change in cerebral metabolic rate (CMRO2). Other parameters measured did not change significantly. A similar response was seen during hypercapnia. Under conditions of raised intracranial pressure (supratentorial subdural balloon) mannitol infusion did not alter cerebral blood flow in three of four animals. In the remaining animal, however, a marked increase in blood flow occurred without any concomitant change in cerebral perfusion pressure. When a further infusion of mannitol was subsequently given to these animals while the intracranial pressure was artificially maintained, there was very little change in cerebral blood flow. The possible causes of the increase in cerebral blood flow at normal intracranial pressure and the clinical implications of these findings are discussed.
Cerebral aspergillosis
Authors: Visudhiphan Pongsakdi , Bunyaratavej Sira , Khantanaphar Suwarindr
Published: May 2009

✓ Three patients with cerebral aspergillosis are reported. Each patient had a different lesion: a solitary brain abscess, a mycotic basilar artery aneurysm, and a massive infective intracranial hemorrhage. Aspergillosis is discussed, including its diagnosis and treatment.
Complications with the Ommaya reservoir in patients with granulomatous meningitis
Authors: Graybill John R. , Ellenbogen Charles
Published: May 2009

✓ Five patients with fungal meningitis whose therapy had involved intraventricular amphotericin B delivered through an Ommaya reservoir developed chemical arachnoiditis in reaction to the amphotericin B, and staphylococcal colonization of the reservoir. The arachnoiditis was successfully treated by reducing dosage of amphotericin B, and the contamination of the reservoir by its replacement.
Ligation of an anterior cerebral artery for aneurysms of the anterior communicating artery complex
Authors: Scott Michael
Published: May 2009

✓ The clinical data on nine patients with aneurysms of the anterior communicating artery complex treated by ligation of an anterior cerebral artery are presented. The long-term follow-up angiograms on five of the eight patients who survived surgery are discussed.
Selective sacral rootlet section for experimental detrusor inhibition
Authors: Gargour Guy W. , Toczek Stanislaw K. , McCullough David C.
Published: May 2009

✓ In 10 dogs, identifiable bundles of motor rootlets were stimulated as they left the conus medullaris at various levels. It is concluded that the bladder musculature is supplied by individual rootlets in variable combinations or patterns, originating from S-1 to S-4, with negligible overlapping innervation of the rectum and lower extremities. This experimental verification of clinical results suggests the possible value of a highly selective rhizotomy in humans with spastic neurogenic bladders (a procedure the authors term “selective sacral rhizidionotomy” from the Greek word rhizidion, meaning rootlet).
Syndromes associated with protrusion of upper lumbar intervertebral discs
Authors: Gutterman Paul , Shenkin Henry A.
Published: May 2009

✓ This report reviews a series of 69 patients operated on for herniations of upper lumbar intervertebral discs and identifies four syndromes related to the principal complaint. These are, in order of frequency, anterior thigh pain, low-back pain only, sciatica, and acute paraplegia. Overall, 78% had satisfactory relief of pain and 93% were improved following laminectomy. Satisfactory results were more common with protrusions at L3–4 than at L2–3. Patients in whom the onset was sciatica had a higher percentage of satisfactory results (94%) than those with anterior thigh pain (70%) or low-back pain alone (80%). Neither of the patients with a paraplegic onset had a good recovery even after removal of the extruded disc.
Chromoblastomycosis in the cisterna magna and the spinal subarachnoid space
Authors: Takahashi Hiroshi , Sasaki Akira , Arai Toshimoto , Tsukamoto Yasushi , Sato Osamu , Sano Keiji
Published: May 2009

✓ This paper reports the first case of chromoblastomycosis affecting the cisterna magna and the spinal subarachnoid space. Suboccipital craniectomy and laminectomy of T-8, 9, and 10 revealed arachnoiditis and multiple granulomas caused by Hormodendrum pedrosi.
Lymphangioma of the craniocervical junction
Authors: Rogers Harry M. , Chou Shelley N.
Published: May 2009

✓ A case of lymphangioma involving bone, primarily the skull and cervical spine, is reported. Pathological and therapeutic considerations are summarized.
Perforation of the anterior annulus during lumbar discectomy
Authors: Shevlin William A. , Luessenhop Alfred J. , Fox John L. , McCullough David C.
Published: May 2009

✓ A case of retroperitoneal vascular injury during removal of a lumbar intervertebral disc is presented. It is proposed that the rapid escape of irrigating saline through the disc space may serve as a reliable sign of surgical perforation of the anterior annulus and anterior longitudinal ligament prior to the appearance of other signs of vascular injury.
External carotid blood supply to acoustic neurinomas
Authors: Levine Harvey L. , Ferris Ernest J. , Spatz Edward L.
Published: May 2009

✓ Two typical verified cases of acoustic neurinoma showed radiological evidence of tumor vasculature supplied from the external carotid artery. In one case there was no demonstrable supply from the vertebrobasilar system while in the other the tumor blood supply from this source was poor and incomplete. In each case the vascular blush shown in external carotid angiography conformed exactly to the size of the tumor found and removed at surgery.
The trapped distal shunt catheter: removal by graded skin traction
Authors: Morantz Robert , Kim Geun , Epstein Fred
Published: May 2009

✓ A hydrocephalic patient had a distal shunt catheter impacted in the heart which could not be removed by the usual surgical means. A technique of graded skin traction was used to remove the catheter successfully.
Reduction of traumatic dislocation of the cervical spine with locked facets
Authors: Cloward Ralph B.
Published: May 2009

✓ The author describes a method and an instrument for reduction of dislocated cervical vertebrae. This technique is particularly useful when the facets are locked.
Primary intracranial esthesioneuroblastoma (olfactory neuroblastoma)
Authors: Hamilton Ann E. , Rubinstein Lucien J. , Poole G. Joseph
Published: May 2009

✓ A case of esthesioneuroblastoma (olfactory neuroblastoma) is reported. Its onset was that of an intracranial tumor, and it subsequently recurred four times. At autopsy, 4 years and 8 months after the onset of symptoms, metastases were found in the cerebrospinal pathways and visceral organs. The literature on this relatively rare neoplasm is reviewed with special reference to the unusual clinical presentation and biological behavior of the tumor.
Automobile accidents caused by unsuspected neurological disease
Authors: Keane James R.
Published: May 2009

✓ Two patients admitted as cerebral trauma cases following single-car automobile accidents were found to have previously-unsuspected, surgically-treatable neurological diseases that undoubtedly caused the accidents. A left posterior communicating artery aneurysm was clipped in one patient and a right frontal lobe abscess aspirated in the other, with excellent results in both patients.
Growth characteristics of experimental intracerebrally transplanted oral epithelium
Authors: VanGilder John C. , Inukai Joel
Published: May 2009

✓ Oral mucosa was transplanted into the brains of 50 baby rats; in 45, viable growth was demonstrated when the animals were sacrificed 1 to 24 months later. The transplants showed stratified squamous, cuboidal, and transitional-like epithelium plus secondary changes such as cholesterol clefts, calcification, and in one case, lamellar bone. The tumors had an unpredictable growth rate. The histological characteristics were those of epidermoids, dermoids, craniopharyngiomas, or Rathke cleft cysts, and suggested a common histogenesis.
Intrasellar or pituitary abscess
Authors: Lindholm Jörgen , Rasmussen Peter , Korsgaard Ove
Published: May 2009

✓ Two patients, each of whom had an isolated intrasellar (pituitary) abscess, are described. A short survey is given of recorded cases.
Intraventricular septations complicating neonatal meningitis
Authors: Schultz Paul , Leeds Norman E.
Published: May 2009

✓ Ventriculography in seven infants who had developed hydrocephalus after surviving neonatal meningitis and ventriculitis disclosed intraventricular septations or veils. These post-inflammatory septations compartmentalized the ventricular system, interfering with attempted shunting procedures. Pathogenesis and treatment are discussed.
Radiological features of the meningoradicular metastases of tumors of the central nervous system
Authors: Pecker Jean , Simon Jacques , Guy Gilles , Carsin Michel , Jan Michel
Published: May 2009

✓ The authors present two cases of intracranial tumors that metastasized through the CSF to the spinal cord and its roots, and discuss the value and hazards of radiological studies in making the diagnosis. Medulloblastomas, pinealomas, and ependymomas are the most common intracranial tumors to metastasize in this fashion. The metastases usually locate in the dural fundus and roots of the cauda equina due to the hydrodynamics of the CSF.
Metastatic intracerebral and intracerebellar Hodgkin's disease
Authors: Brazinsky John H.
Published: May 2009

✓ The author reports the rare occurrence of Hodgkin's disease metastatic to the cerebrum and cerebellum.
Bilateral asymmetrical extradural hematomas
Authors: Soni Sangham R.
Published: May 2009

✓ A case is described in which bilateral asymmetrical extradural hematomas became symptomatic at different times.
Sudden loss of vision following alcohol block of the infraorbital nerve
Authors: Markham James W.
Published: May 2009

✓ The unusual complication of sudden ipsilateral loss of vision following alcohol block of the infraorbital nerve for tic douloureux is described and the possible physiopathology discussed. The author believes that spasm of the central retinal artery was the cause and that repeated injections may have been a predisposing factor. Review of other cases reported shows that the loss of vision has been attributed to embolization of injected agents via collateral blood vessels.
Angiographic evidence of spontaneous closure of nontraumatic arteriovenous fistula of the vertebral artery
Authors: Kim Young H. , Gildenberg Philip L. , Duchesneau Paul M.
Published: May 2009

✓ A case is reported in which a congenital arteriovenous fistula of the left vertebral artery closed spontaneously 4 years after becoming symptomatic. The course was followed and confirmed by retrograde left brachial angiography.
Surgical treatment of symptomatic carotid stenosis and asymptomatic ipsilateral intracranial aneurysm
Authors: Denton Ira C. , Gutmann Ludwig
Published: May 2009

✓ The occurrence of symptomatic carotid stenosis and asymptomatic ipsilateral intracranial aneurysm is reported. The successful management by planned staged surgical treatment of both lesions is discussed.
Surgical treatment of laterally ruptured cervical disc
Authors: Murphey Francis , Simmons James C. H. , Brunson Bruce
Published: May 2009

✓ From the analysis of 648 patients operated on for ruptured cervical discs between 1939 and March of 1972 and a follow-up study of 380 of these patients, the following conclusions seem justified. Osteophytes or hypertrophic spurs rarely produced the classical clinical picture or deficits. Ninety per cent of the patients awakened in the morning with pain in the neck and rhomboid region. Ten per cent had a history of injury, but there was no characteristic pattern as in lumbar discs. Only one patient had a typical hyperextension injury. Anterior chest pain occurred in one-fifth of the cases. Pain in the neck, rhomboid region, and anterior chest was referred from the discs, while the arm pain was usually the result of nerve root compression; however, in a few cases the degenerating disc caused referred pain to the arm without any nerve root pressure. Since accurate diagnosis can be made on clinical grounds, myelography is not necessary in most cases. In our experience conservative treatment was usually unsuccessful while the surgical results were better than in almost any other neurosurgical operation. The nerve root syndromes associated with extruded lateral cervical discs are outlined and the indications and contraindications for myelography discussed.
Results of adequate posterior decompression in the relief of spondylotic cervical myelopathy
Authors: Fager Charles A.
Published: May 2009

✓ The author reports his experience with 35 cases of spondylotic myelopathy treated by extensive laminectomy and section of the dentate ligament. After a follow-up of 1 to 7 years, 24 patients have maintained distinct improvement; in nine the disability has not improved and in two it has become worse. The technique is described, and postoperative myelograms are used to demonstrate the improvement.
Experience with 88 consecutive cases of brain abscess
Authors: Morgan Howard , Wood Matthew W. , Murphey Francis
Published: May 2009

✓ The records of 88 patients with intraparenchymal brain abscess treated during 1946–1971 were reviewed. The incidence of brain abscess did not decline significantly during this period. The overall mortality rate was 36.4%, and the operative mortality rate 29.1%. The most frequent findings were alteration of consciousness, headache, and elevated peripheral white blood cell count; fever, hemiparesis, seizures, neck stiffness, nausea and vomiting, and papilledema were less common. Lumbar puncture was a definite threat to the patient with a brain abscess. Ventriculography appeared slightly superior to angiography in accurately localizing the site of the abscess. There was a close correlation between the preoperative level of consciousness and the operative mortality rate. With the aid of Thorotrast, simple aspiration or drainage was superior to excision; when Thorotrast was not used, excision produced better results. The rate of postoperative seizure disorder was similar regardless of the type of treatment. The operative mortality rate and the postoperative neurological sequelae were less for intracerebellar abscesses than for intracerebral abscesses.
Significance of upward gaze palsy (Parinaud's syndrome) in hydrocephalus due to shunt malfunction
Authors: Shallat Ronald F. , Pawl Ronald P. , Jerva Michael J.
Published: May 2009

✓ Several cases are presented in which Parinaud's syndrome or upward gaze palsies were associated with hydrocephalus due to non-neoplastic aqueductal occlusion. In some of these cases the ocular signs proved to be an early and reliable indicator of increased intraventricular pressure due to shunt malfunction. The possible mechanisms by which this phenomenon occurs are discussed. The importance of differentiating such cases from those of neoplastic origin and the value of third ventriculography are stressed.
Effect of positional changes and jugular vein compression on the pressure gradient across the arachnoid villi and granulations of the dog
Authors: Potts D. Gordon , Deonarine Vishnu
Published: May 2009

✓ The pressure gradient between the distal subarachnoid space and the superior sagittal sinus was measured in dogs and the effects of positional changes and jugular venous compression investigated. This pressure gradient remained almost constant in the head-up, head-down, and horizontal positions. These findings would be consistent with a passive filtration system for the return of cerebrospinal fluid from the distal subarachnoid space to the superior sagittal sinus and adjacent veins. The pressure gradient rose with jugular venous compression.
Anti-siphon and reversible occlusion valves for shunting in hydrocephalus and preventing post-shunt subdural hematomas
Authors: Portnoy Harold D. , Schulte Rudolf R. , Fox John L. , Croissant Paul D. , Tripp Lucius
Published: May 2009

✓ An anti-siphoning valve for use in hydrocephalic shunt systems is described. The addition of this valve to the system effectively reduces the hazard of negative intraventricular pressure when the patient is sitting or standing. The formation of post-shunt subdural hematomas was prevented by temporary postoperative occlusion of the shunt using a percutaneously reversible occlusion valve, which is also described.
Brain 22Na uptake in experimental cerebral microembolism
Authors: Siegel Barry A. , Studer Rebecca K. , Potchen E. James
Published: May 2009

✓ The authors report that brain edema following cerebral microembolism in rats is accompanied by significant increases in brain sodium and cerebral 22Na uptake. Their results suggest that in vivo measurement of brain 22Na uptake may be useful for the detection of cerebral edema.
Experimental local thalamic application of xylocaine through silicone rubber chemode
Authors: Tsutsumi Hiroshi , Mark Vernon H.
Published: May 2009

✓ Utilizing the unique nature of silicone rubber, the authors introduced minute quantities of xylocaine into the centromedian thalamic nucleus of squirrel monkeys via a chronically implanted brain cannula capped with its membrane (Silastic chemode) and tested the monkeys with a conditioned pain response. Intrathalamic xylocaine began to raise the pain threshold at 40 min postinjection, reached maximum effectiveness at 70 min, and maintained this threshold for more than 2 hours.
Spontaneous etrusion of the abdominal tube through the umbilicus complicating peritoneal shunt for hydrocephalus
Authors: Adeloye Adelola
Published: May 2009

✓ This paper reports the spontaneous extrusion of the abdominal portion of a ventriculoperitoneal shunt through the umbilicus. Some of the possible predisposing factors are discussed.
Chondroblastoma of the cervical spine
Authors: Wisniewski Marian , Toker Cyril , Anderson Paul J. , Huang Yun P. , Malis Leonard I.
Published: May 2009

✓ A rare case of benign chondroblastoma of the cervical spine is described, and the differential diagnosis of benign lesions in the spine discussed.
Acute carpal tunnel syndrome secondary to thrombosis of a persistent median artery
Authors: Maxwell John A. , Kepes John J. , Ketchum Lynn D.
Published: May 2009

✓ A rare case of thrombosis of a persistent median artery as a cause of acute carpal tunnel syndrome is reported. The sudden onset of pain, local tenderness of the palm, and decreased sensation in the median nerve distribution were the symptoms. The operative findings and subsequent progress are described.
Surgery of ulnar neuropathy at the elbow: 16 cases treated by decompression without transposition
Authors: Wilson Donald H. , Krout Robert
Published: May 2009

✓ The authors report 16 consecutive cases of ulnar nerve palsy at the elbow successfully relieved by simple division of the tendinous insertions of the flexor carpi ulnaris, which form the roof of the “cubital tunnel.” They believe the more complex procedures of anterior transposition of the nerve or resection of the medial epicondyle are unnecessary, and even undesirable.
An alternate venous route for ventriculoatrial shunts
Authors: Verdura Javier , Resnikoff Samuel , Cardenas Juan
Published: May 2009

✓ A safe, simple, surgical technique to cannulate the subclavian vein for ventriculoatrial shunts is described. The convenience of using this vessel to gain access to the right atrium when the internal jugular vein is not available is discussed, and experience with five cases is reported.
Angiography of the spinal cord
Authors: Chiro Giovanni Di , Wener Louis
Published: May 2009

✓ The authors present a current review of the development, techniques, and applications of angiographic studies of the spinal cord, with special emphasis on selective arteriography.
Stereotaxic treatment of frontal-lobe and centrencephalic epilepsy
Authors: Jelsma Richard K. , Bertrand Claude M. , Martinez Sonis N. , Molina-Negro Pedro
Published: May 2009

✓ The authors report a series of selected epileptic patients treated by stereotaxic lesions. The treatment was successful in patients with focal motor epilepsy. Stereotaxic lesions made in patients with centrencephalic electroencephalographic abnormalities were only successful if there was also clinical evidence of a frontal focus. The significance of these results is discussed, and a target is described that may be useful in certain cases with clinical evidence of a frontal lobe focus.
Neurophysiological assessment of afferent and efferent conduction in the injured spinal cord of monkeys
Authors: Deecke Lüder , Tator Charles H.
Published: May 2009

✓ Controlled compression of the spinal cord at a given pressure using the circumferential cuff technique has yielded consistent, reproducible cord injury in primates. To test the constancy of the mechanical factors involved, functional tests were performed to study spinal cord conduction before, immediately after, and up to 3 hours after the injury. Two long fiber tracts were tested, the dorsal funiculus and the pyramidal tract. Afferent conduction testing was carried out extradurally recording the afferent volley in the posterior column following sciatic nerve stimulation. The normal triphasic volley before injury changed after injury into a large monophasic positive “killed end potential” at the site of the lesion; an iso-electric line rostral to the lesion site indicated a complete afferent conduction block up to the end of the experiment (3 hours after injury). Efferent conduction was tested by stimulating the pyramidal tract in the cord above the injury site with a special extradural electrode and observing the most distal hind limb movements (flexion of the hallux). The neurophysiology of this type of spinal cord recording and stimulation is discussed as well as its possible importance in establishing the severity of a spinal cord injury, the response to treatment, and the prognosis in patients with spinal cord injuries.
Evaluation of experimental spinal cord injury using cortical evoked potentials
Authors: Martin Stephen H. , Bloedel James R.
Published: May 2009

✓ Experiments were performed to determine if changes in cortical evoked responses could be used to predict the extent of the neurological deficits following spinal cord injury by sudden inflation of a Fogarty balloon in the epidural space cephalad to a laminectomy. The cortical responses to stimulation of the posterior tibial nerve were recorded over the sigmoid gyrus at various times following the lesion and compared with the control response. Severe, irreversible neurological deficits occurred in cats in which the cortical response either could not be evoked immediately after injury or disappeared rapidly during this period. At the end of at least 6 weeks following injury, all of these animals were paraplegic and showed severe cystic degeneration of the spinal cord. In animals in which the post-injury cortical response did not completely disappear, only mild changes were observed in a spinal cord 6 weeks following injury. This technique may be helpful in ascertaining the severity and irreversibility of a traumatic spinal cord lesion; because the technique is simple, the method may prove helpful in the clinical management of patients with spinal cord injury.
The histological accuracy of the smear technique for neurosurgical biopsies
Authors: Marshall Lawrence F. , Adams Hume , Doyle David , Graham David I.
Published: May 2009

✓ The preparation of smears from neurosurgical biopsy material is one technique by which a rapid diagnosis may be made available to the neurosurgeon. This technique is particularly appropriate for the small soft pieces of tissue obtained by needle biopsy. The 190 consecutive smear biopsies examined in this Institute during 1971 were reviewed and compared with subsequent paraffin sections of the same biopsies. In 94% of cases the correct diagnosis was obtained from the smears. Most of the errors stemmed from failure to distinguish between different types of malignant tumor. It is suggested that the smear technique is the most appropriate available for rapid neurosurgical diagnosis.
Angiographic resolution of a neonatal intracranial cavernous hemangioma coincident with steroid therapy
Authors: Prensky Arthur L. , Gado Mokhtar
Published: May 2009

✓ A case is reported in which an inoperable cavernous hemangioma present from birth and involving the left orbit and left middle cranial fossa was totally resolved as the patient was treated with large doses of steroids. During treatment the patient exhibited a persistent thrombocytosis. Serial angiographic studies indicated that resolution was accompanied by occlusion of the branches of the internal and external carotid arteries feeding the lesion.
Gross pulmonary embolization with cerebral tissue following head trauma
Authors: Legier Jacques , Rinaldi Italo
Published: May 2009

✓ A case of gross pulmonary embolization by cortical brain tissue is described. The likelihood of a superimposed coagulating process induced by the thromboplastic effect of cerebral phospholipids is discussed.
Cerebral blood flow regulation during experimental brain compression
Authors: Miller J. Douglas , Stanek Albert E. , Langfitt Thomas W.
Published: May 2009

✓ The effect of brain compression on cerebral blood flow was measured in 13 anesthetized, ventilated dogs by inflation of extradural balloons. The effects of the raised intracranial pressure, so produced, were correlated with the presence or absence of autoregulation of cerebral blood flow to induced changes of arterial pressure, which was tested immediately prior to each episode of inflation of the balloon. Cerebral blood flow was measured by a venous outflow method and monitored continuously, together with arterial and supratentorial intracranial pressure; arterial pCO2 and body temperature were held constant. Three stages were identified. When autoregulation to a change of arterial pressure was intact, initial inflation of the balloon did not reduce cerebral blood flow until the difference between arterial and intracranial pressure (which was taken to represent cerebral perfusion pressure) was less than 40 mm Hg. When autoregulation was impaired, which occurred after the first inflation of the balloon or was due to preceding arterial hypotension, raised intracranial pressure caused an immediate reduction of cerebral blood flow. At this stage of impaired autoregulation there was a tendency for hyperemia to develop on deflation of the balloon. Finally, after repeated inflation and deflation of the balloon, when brain swelling supervened, cerebral blood flow decreased steadily and failed to increase despite induced increases of arterial pressure and cerebral perfusion pressure.
Delineation of the thalamic nuclei with a microelectrode in stereotaxic surgery for parkinsonism and cerebralpalsy
Authors: Fukamachi Akira , Ohye Chihiro , Narabayashi Hirotaro
Published: May 2009

✓ Extracellular thalamic recording with semi-microelectrode during 103 cases of stereotaxic surgery identified the upper and lower borders of the thalamus and the anterior limit of the sensory area. In adults the upper border of the thalamus was found 13 to 21 mm above the intercommissural line and the lower border within 1 mm above and below the intercommissural line. In children under 10 years with cerebral palsy, the upper border was comparable to that in adults while the lower border was about 1 mm below the intercommissural line. In adults the inferior border determined by the thalamocortical evoked potential was always about 2 to 3 mm above the intercommissural line. The anterior limit of the sensory nucleus, which seemed to be specifically related to the neurons activated by muscle compression and active or passive joint movement, was 3 to 4 mm behind the perpendicular line at the midpoint of the intercommissural line. The target point was determined by using these physiological findings combined with radiological control. This method has produced improved operative results in the treatment of parkinsonism.
The role of intracranial pressure in the arrest of hemorrhage in patients with ruptured intracranial aneurysm
Authors: Nornes Helge
Published: May 2009

✓ Intracranial epidural pressure (EDP) was recorded in 29 patients admitted with ruptured saccular aneurysms, but unfit for immediate surgery. In 10 patients a total of 13 recurrent hemorrhages were recorded; the average time before rerupture was 7.7 days after the last hemorrhage. Ten of the rebleedings started from intracranial pressure levels at or below 400 mm H2O whereas three started from higher prerupture levels. The observations indicate an increasing risk of rebleeding as the epidural pressure decreases toward normal pressure. Most repeat hemorrhages are arrested at EDP levels about that of the diastolic blood pressure. The resulting reduced pressure gradient across the aneurysm wall is important in the arrest of hemorrhage and the maintenance of hemostasis. Measurement of internal carotid artery blood flow during the acute stage of recurrent hemorrhage shows marked changes in blood flow pattern. Arrest of blood flow occurred only at the end of diastole; forward flow occurred only during systole. The effect of intracranial-pressure-buffering mechanisms on the increased EDP after rupture is discussed. Activation of these mechanisms may reduce the EDP to acceptable pressure levels within minutes and should be awaited before decompressive management is considered. Continuous recording of the EDP in patients unfit for immediate aneurysm surgery is important in the selection of the optimal time for operation.
Relief of postherpetic neuralgia with psychotropic drugs
Authors: Taub Arthur
Published: May 2009

✓ Five patients with postherpetic neuralgia experienced almost complete relief of pain within 1 to 2 weeks after the institution of therapy with amitriptyline and a substituted phenothiazine. Three of the group had shown no response to amitriptyline or nortriptyline alone; one had had symptoms exacerbated by surgical denervation. In three, discontinuance or diminution of the dose of the phenothiazine was followed by return of pain, which was then relieved with reinstitution. The results suggest that an appropriate combination of tricyclic antidepressant and substituted phenothiazine medication may decrease the necessity for surgical intervention in postherpetic neuralgia.
Aneurysm of the anterior choroidal artery with intraventricular hematoma and hydrocephalus
Authors: Papo Isacco , Salvolini Ugo , Caruselli Giuseppe
Published: May 2009

✓ An aneurysm of the intraventricular portion of the anterior choroidal artery is reported. Rupture of the aneurysmal sac had given rise to extensive intraventricular clotting, cisternal blockade, and the development of hypertensive tetraventricular hydrocephalus. A combination of pneumoencephalography, angiography, and tomography defined the exact nature and topography of the lesion. The vascular malformation was removed and a ventriculoatrial shunt inserted. The patient, who was severely arteriosclerotic and hypertensive, died from myocardial infarction 3 months after surgical treatment.
Dose dependency of Decadron in patients with partially excised brain tumors
Authors: Renaudin Justin , Fewer Derek , Wilson Charles B. , Boldrey Edwin B. , Calogero John , Enot K. Jean
Published: May 2009

✓ Twenty patients seriously ill following subtotal excision of brain tumors were given unusually large doses of Decadron to restrain peritumoral edema. The prompt clinical effect was strikingly favorable in 11. The dosage of Decadron above which no additional anti-edema effect occurs must be established for each individual patient. No significant complications occurred under dosages ranging from 32 to 96 mg/day. Brain scintiscans performed after rapid clinical improvement in five cases showed no change.