bluuebunny/crossref_metadata_2025 huggingface dataset:
Posttraumatic bilateral vertebral artery occlusion
Authors: Six Eric G. , Stringer W. Lynn , Cowley A. Ron , Davis Courtland H.
Published: May 2009

✓ A case of bilateral vertebral artery occlusion following trauma in a 25-year-old woman is presented. The patient had minimal subluxation of C-2 on C-3 without neurological deficit. Her neck was immobilized for 16 days, and then a posterior fixation of C-1 through C-4 was performed with Kirschner wires and methyl methacrylate. Occlusion of the vertebral arteries has persisted, but collateral vessels are adequate and the patient has remained neurologically normal.
Enterogenous cyst of the fourth ventricle
Authors: Afshar Farhad , Scholtz Carl L.
Published: May 2009

✓ A case of a benign cyst within the fourth ventricle is described. The histology of the cyst wall lining resembled that of an enterogenous cyst of the spinal cord. The relationship between this cyst, colloid cysts of the third ventricle, and enterogenous cysts of the spinal cord is discussed.
Primary pituitary aspergillosis responding to transsphenoidal surgery and combined therapy with amphotericin-B and 5-fluorocytosine
Authors: Ramos-Gabatin Angelita , Jordan Richard M.
Published: May 2009

✓ Pituitary abscess is an unusual cause of sella turcica enlargement. Because its presentation closely mimics that of a pituitary tumor, the condition is seldom recognized preoperatively. Most cases have been of bacterial etiology; however, a single patient with a primary mycotic pituitary abscess secondary to Aspergillus species has been reported. That patient died of diffuse Aspergillus meningoencephalitis following a transfrontal craniotomy. In the present case, a woman with primary pituitary aspergillosis survived her infection with virtually intact pituitary function following a transsphenoidal approach which avoided contamination of cerebrospinal fluid. Postoperative amphotericin-B and 5-fluorocytosine therapy probably contributed greatly to her survival. Factors that should alert the clinician to the presence of a pituitary abscess in a patient with sella turcica enlargement are prior episodes of meningitis, sinusitis, or cerebrospinal fluid abnormalities, including pleocytosis, depressed glucose, and elevated protein.
Intramedullary nerve implantation in amputation and other traumatic neuromas
Authors: Hemmy David C.
Published: May 2009

✓ A simple and effective method of eliminating pain as a result of amputation and traumatic neuroma is described. Following excision of the neuroma, intramedullary long-bone implantation of the proximal nerve is performed. This technique has been used in five patients and there has been no recurrence of pain.
Immunological aspects of intrinsic glial tumors
Authors: Apuzzo Michael L. J. , Mitchell Malcolm S.
Published: May 2009

✓ Fundamental concepts of general tumor immunology and modes of immunotherapy are presented. Significant work dealing with the relationship of the immune system to intrinsic glial neoplasms is reviewed in relation to therapeutic applications and future investigative efforts.
Complement fixation by IgM and IgG autoantibodies on cultured human glial cells
Authors: Garson Jeremy A. , Quindlen Eugene A. , Kornblith Paul L.
Published: May 2009

✓ The humoral immune response to autologous gliomas has been investigated in 16 patients using immune adherence and anti-C3 immunofluorescence assays of serum samples. Significant antiglioma antibody activity was detected in 56% of these sera. Fractionation experiments demonstrated that IgM class antibodies were more effective than IgG in their ability to fix complement on cultured glioma cell membranes. In addition, autologous IgG was shown to inhibit IgM complement-fixing activity in some experiments. “Capping” of immune complexes on the glioma cell surface is also described.
Radiation treatment for medulloblastoma
Authors: Berry Martin P. , Jenkin R. Derek T. , Keen Colin W. , Nair Bhavani D. , Simpson W. John
Published: May 2009

✓ One hundred and twenty-two patients with medulloblastoma received postoperative irradiation at the Princess Margaret Hospital, Toronto, from 1958 to 1978, inclusive. The surgical procedure in these patients was total resection (44 patients), subtotal resection (66 patients), or biopsy alone (12 patients). Twenty-five patients received adjuvant chemotherapy.

Overall 5- and 10-year survival rates were 56% and 43%, respectively. Improved survival rates were associated with an increased degree of resection and with posterior fossa radiation doses of 5200 rads or more. The posterior fossa was the common site of first relapse (in 56 patients, 46%). Systemic metastases at first relapse occurred in 18 of 52 patients (35%), and were associated with the use of ventriculosystemic shunts. Millipore filters did not prevent systemic relapse in shunted patients.

A subset of 15 patients who received a posterior fossa dose of 5200 rads or more after a total resection had a 5-year survival rate of 77%, which remained constant to 10 years. This result is considered to be the upper limit that can be achieved by current treatment methods.
Predicting the need for operation in the patient with an occult traumatic intracranial hematoma
Authors: Galbraith Sam , Teasdale Graham
Published: May 2009

✓ Computerized tomography scanning has shown that acute traumatic intracranial hematomas are more common than was previously realized, but whether all hematomas must be removed remains controversial. About half of this series of 26 patients who were not clinically deteriorating and who were initially managed without operation had to undergo hematoma removal because they subsequently deteriorated. Features present at the time of diagnosis (age, type and site of hematoma, presence of focal signs, level of responsiveness, and degree of midline shift) were not helpful in predicting that operation would be needed. The only discriminatory factor was the level of intracranial pressure (ICP). All the patients with ICP greater than 30 mm Hg deteriorated and required operation, but only one patient whose ICP was less than 20 mm Hg deteriorated. Half the patients with ICP between 20 and 30 mm Hg did not require an operation. Intracranial pressure monitoring can, therefore, be useful in managing patients with an occult intracranial hematoma.
Infarction of the spinal cord as a complication of pneumococcal meningitis
Authors: Haupt Helen M. , Kurlinski John P. , Barnett Nancy K. , Epstein Mel
Published: May 2009

✓ Spinal cord infarction in association with pneumococcal meningitis has not been previously recognized. The case is reported of a 5½-year-old boy who had Streptococcus pneumoniae meningitis complicated by the sudden onset of flaccid paraplegia and loss of all sensory modalities below the level of T-2. At operation, the spinal cord was pale and enveloped by dense adhesions, suggesting compromise of the arterial vasculature with concomitant infarction.
Simultaneously occurring prolactinomas
Authors: Powers Stephen K. , Wilson Charles B.
Published: May 2009

✓ The case of a patient with two separate prolactin-secreting pituitary adenomas is presented. The importance of thorough inspection of the pituitary gland at operation is emphasized.
Intracranial granuloma as an unusual complication of subdural peritoneal shunt
Authors: Korosue Kazuyoshi , Tamaki Norihiko , Matsumoto Satoshi , Ohi Yoshiyuki
Published: May 2009

✓ The authors report a rare case of intracranial granuloma as a complication of subdural-peritoneal shunting for the treatment of subdural effusion. The necessity of the removal of the entire shunt system as soon as the subdural effusion has cleared is emphasized.
Air embolism from wounds from a pin-type head-holder as a complication of posterior fossa surgery in the sitting position
Authors: Cabezudo José M. , Gilsanz Fernando , Vaquero Jesús , Areitio Eduardo , Martinez Roberto
Published: May 2009

✓ The authors report an unusual case of intraoperative air embolism during posterior fossa surgery in the sitting position. The source of air was one of the wounds made by the pin-type skull fixation device. We suggest that the patients should not be released from such device until they are in the supine position.
Differentiation of medulloblastoma
Authors: Palmer James O. , Kasselberg Alfred G. , Netsky Martin G.
Published: May 2009

✓ A series of medulloblastomas was studied by light microscopy. The tumors were variable: astrocytic, ependymal, neuronal, and probable oligodendroglial differentiation was present. Features of glioblastoma multiforme occurred in one case. Immunoperoxidase staining for glial fibrillary acidic protein (GFAP), an antigen found only in astrocytes and ependymal cells, revealed astrocytic differentiation in 11 of 13 cases. The two GFAP-negative tumors were histologically undifferentiated. A new classification of medulloblastomas is presented, based on the multiple types of differentiation of these tumors. Neuronal, astrocytic, ependymal, and small-cell types are described. Undifferentiated tumors were more frequent in younger children. The differentiation of medulloblastoma is correlated with recent experimental studies of gliogenesis and neurogenesis. A hypothesis that medulloblastoma is a stem-cell neoplasm is presented, based on these comparative data.
Hemispheric supratentorial astrocytomas in children
Authors: Mercuri Sandro , Russo Antonio , Palma Lucio
Published: May 2009

✓ In a series of 41 cases of hemispheric supratentorial astrocytoma (HSA) in children, 29 patients have been followed for periods ranging from 5 to 27 years. The follow-up data show that HSA's are relatively benign tumors. Twenty-two patients (76%) are still living: 12 in good, eight in fair, and two in poor neurological condition. Their mean survival is 13.3 years. Five patients died from tumor recurrence within 4 years of the operation. All five were operated on before the age of 8 years. The best results in terms of mean survival and quality of life were obtained in cases of cystic HSA, especially the pilocytic variety. In children, HSA tends to take the cystic form (often pilocytic), and its relatively benign course points up an analogy between this rare supratentorial tumor and the more common tumor of the cerebellum (the so-called “cerebellar astrocytoma”).
Pituitary apoplexy: its incidence and clinical significance
Authors: Wakai Susumu , Fukushima Takanori , Teramoto Akira , Sano Keiji
Published: May 2009

✓ The occurrence of hemorrhage from pituitary adenoma (so-called “pituitary apoplexy”) was investigated in a consecutive series of 560 cases operated on during the past 30 years. There were 93 cases (16.6%) in which hemorrhage from pituitary adenomas was confirmed either clinically or surgically. These patients were analyzed in terms of age, sex, symptoms and signs, size of tumor, hormonal function, and histological types of adenomas, and computerized tomography findings. In 90 cases (16.1%), hematoma or old bloody fluid was verified within the tumor tissue at surgery. Three other patients presented with subarachnoid hemorrhage, but there was no detectable intratumor hematoma in any of them. Among these 93 patients, 42 (7.5%) showed no evidence of clinical symptoms related to hemorrhage (asymptomatic hemorrhage). Fifty-one patients (9.1%) had definite histories of an acute episode that suggested sudden bleeding (symptomatic hemorrhage: pituitary apoplexy). Thirty-eight patients (6.8%) had a major attack manifested by disturbances of consciousness, hemiparesis, loss of vision, or ocular palsy. In two acromegalic patients, pituitary apoplexy developed during bromocriptine treatment. There was one case of sudden death due to massive hemorrhage from the tumor 14 months after the completion of postoperative radiation therapy. The other 13 symptomatic patients (2.3%) developed a minor attack which included headache, nausea, vomiting, and vertigo.

Bleeding from pituitary adenomas was not statistically correlated with any of the following factors: sex, hormonal function of adenomas, and histological types, but it was correlated with age. The number of asymptomatic cases in the third decade was significantly greater than that of the whole group of pituitary adenoma patients in the same decade. The present investigation revealed that the incidence of pituitary apoplexy was unexpectedly high: a major attack in 6.8% of pituitary adenoma patients, a minor attack in 2.3%, and asymptomatic hemorrhage in 7.5% of the cases. This risk of pituitary apoplexy should be kept in mind in treating pituitary adenomas.
Effect of methylprednisolone in compression trauma to the feline spinal cord
Authors: Means Eugene D. , Anderson Douglas K. , Waters Thomas R. , Kalaf Leila
Published: May 2009

✓ The purpose of this study was to determine the effect of methylprednisolone sodium succinate on clinical recovery and tissue preservation following compression trauma of feline spinal cord. Cats were anesthetized with pentobarbital and injured by placing a 170-gm weight on the spinal cord for 5 minutes. One hour after injury, the animals were given intravenous steroid (15 mg/kg/day) for 2 days in three divided doses, 15 mg/kg/day for 1 day intramuscularly, 7.5 mg/kg/day intramuscularly for 3 days, and 3.75 mg/kg/day intramuscularly for 3 days, for a total of 9 days. In a control group, the animals were injured but untreated. At 60 days after injury, the animals were sacrificed by perfusion fixation with 10% formalin. The spinal cord was removed and evaluated for a number of morphometric parameters, including percentage of spinal cord cross-sectional area containing the cavity (%area) and percentage of spinal cord volume occupied by the cavity (%volume). A clinical recovery score (recovery index) was devised to evaluate neurological recovery. Steroid-treated cats showed significantly greater recovery than the untreated controls (p < 0.001). Moreover, the spinal cord of treated cats displayed greater tissue preservation as measured by %area (p < 0.005) and %volume (p < 0.004). Correlation coefficients comparing the recovery index with morphometric parameters revealed a negative correlation between cavity size and recovery. These data provide evidence for a beneficial effect of methylprednisolone in promoting recovery and preserving spinal cord tissue following blunt injury to the feline spinal cord.
Zones in the cerebellar cortex
Authors: Haines Duane E.
Published: May 2009

✓ The organization of zones in the cerebellar cortex, as reflected by the arrangement of cortical efferent and afferent fibers, was reviewed with special emphasis on the anterior lobe. There is conclusive evidence for the existence of at least six, and possibly as many as nine, ipsilateral rostrocaudally oriented cortical zones, each having specific afferent and efferent connections. The topography of afferent and efferent fibers of the cerebellar cortex and/or the spatial arrangement of cortical zones have not been given appropriate attention in both experimental and clinical studies dealing with focal electrical stimulation of the cerebellum. It is suggested that inattention to the relationships between electrode placement and zones in the cerebellar cortex may be partially responsible for the sometimes capricious results during and/or subsequent to cerebellar cortical stimulation.
Craniosynostosis in vitamin D-resistant rickets
Authors: Roy William A. , Iorio Robert J. , Meyer Glenn A.
Published: May 2009

✓ Craniosynostosis and associated craniofacial deformities, such as frontal bossing, often occur as symptoms of vitamin D-resistant rickets in children. Similar skull deformities develop in mice with X-linked dominant hypophosphatemia, the most common form of vitamin D-resistant rickets. These mice have a short, wide, high neurocranium, which suggested an inhibition of coronal suture growth. To study this question, we compared histologically the postnatal development of the coronal sutures in normal and hypophosphatemic mice between 1 and 13 weeks of age. Premature fusion of the coronal suture occurred in hypophosphatemic mice by 4 weeks of age. The proportion of the suture obliterated by bone varied among individual animals, but craniosynostosis was present in all animals studied at 4 weeks and older. Fusion of the coronal suture did not occur through 13 weeks of age in any of the normal mice studied. The X-linked hypophosphatemic mouse is an animal model that can be used to study the role of vitamin Dresistant rickets in the development of craniosynostosis, to relate craniosynostosis to the development of associated skull deformities, and to test new treatment procedures.
Conservative management of a mesencephalic tuberculoma
Authors: Bravo Gonzalo , Vaquero Jesús , Martínez Roberto , Cabezudo José
Published: May 2009

✓ A case of clinically unsuspected mesencephalic tuberculoma that was diagnosed at operation is presented. After intraoperative diagnosis, the surgical procedure was interrupted and specific treatment with tuberculostatic agents was started. The symptoms remitted totally in a few months. This conservative management is preferable to surgical removal when the diagnosis of brain-stem tuberculoma has been established.
Manifestations and therapeutic considerations in pineal yolk-sac tumors
Authors: Murovic Judith A. , Ongley James P. , Parker Joseph C. , Page Larry K.
Published: May 2009

✓ A 20-month-old patient with a paraventricular and parapineal yolk-sac tumor was treated with subtotal excision and total neuraxis irradiation. She has done well in the 3½ years since surgery. A comparative review of similar pineal and gonadal yolk-sac tumors suggests a role for surgery combined with radiotherapy and chemotherapy. Additional experience with these unusual germ-cell neoplasms should establish the need for aggressive extirpation, not only to determine the exact diagnosis, but also to provide the basis for subsequent adjunctive therapy. The latter may include specific combinations of antineoplastic drugs in addition to radiation.
Microsurgical removal of paraventricular cavernous angiomas
Authors: Pozzati Eugenio , Gaist Giulio , Poppi Massimo , Morrone Bernardino , Padovani Roberto
Published: May 2009

✓ Two cases of paraventricular cavernous angiomas are presented. In one, the cavernous angioma was found in the right wall of the fourth ventricle, and in the other in the right thalamus encroaching upon the third ventricle. Both patients had onset of symptoms suggesting a tumor. Good results were obtained by the microsurgical approach to these malformations. The computerized tomography findings typical of cavernous angiomas are reviewed.
Clinical and pathological study of dysplastic gangliocytoma
Authors: Roski Richard A. , Roessmann Uros , Spetzler Robert F. , Kaufman Benjamin , Nulsen Frank E.
Published: May 2009

✓ A case of dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos disease) is reported. Computerized tomography revealed a nonenhancing mass lesion surrounded by areas of calcification. Surgical excision resulted in complete resolution of the patient's symptoms. The histological findings support the concept that this tumor represents a congenital abnormality in granule-cell migration and is not a true neoplasm.
Traditions, Transition, and the Torch
Authors: King Robert B.
Published: May 2009

✓ The President of the American Association of Neurological Surgeons (AANS) emphasizes the need to participate actively in the burgeoning field of neuroscience, and the unique opportunity of neurological surgeons to apply the new knowledge to the treatment of their patients. Clinician-investigators need to be trained in their formative years in the methodology and techniques of modern neurobiology. Diminishing governmental support for training poses a grave threat to carrying on the tradition of research in neurological surgery. To meet a critical need, the formation of a Research Foundation is announced as a function of the AANS. As Science is expanded and applied, the Art of neurosurgery will continue to be refined, along with the high tradition of Ethics which has been handed down over the years as part of the heritage of neurological surgeons.
Dorsal root entry zone lesions to control central pain in paraplegics
Authors: Nashold Blaine S. , Bullitt Elizabeth
Published: May 2009

✓ Thirteen patients with intractable long-term pain following spinal cord injury and paraplegia were treated with dorsal root entry zone lesions placed at the level just above the transection. Pain relief of 50% or more was achieved in 11 of the 13 patients, with follow-up periods ranging from 5 to 38 months. A previous report showed that central pain from brachial plexus avulsion could be relieved by dorsal root entry zone lesions, and this technique has been extended to the central pain phenomena associated with spinal trauma and paraplegia.
Management of vein of Galen aneurysms
Authors: Menezes Arnold H. , Graf Carl J. , Jacoby Charles G. , Cornell Steven H.
Published: May 2009

✓ Aneurysms of the great vein of Galen are rare and potentially lethal lesions, especially in early infancy. Sectioning of the feeding arteries and excision of the lesion have been proposed for the best long-term results. An alternative approach was utilized in the two children discussed here. The computerized tomography (CT) scan established the precise diagnosis and demonstrated hydrocephalus and cortical atrophy preoperatively. Parieto-occipital craniotomy with an interhemispheric approach was performed to clip the numerous feeders. The procedure was terminated when the sac collapsed and blood aspirated from the lesion was venous in oxygen saturation. A Doppler probe over the aneurysm then revealed a venous flow. Serial postoperative CT scans demonstrated that the mass had shrunk in size. Follow-up angiography was not thought necessary.
Transient abducens paresis after shunting for hydrocephalus
Authors: Black Peter McL. , Chapman Paul H.
Published: May 2009

✓ In two cases of normal pressure hydrocephalus, the patients suffered transient abducens weakness following a shunting procedure.
Lymphocyte subpopulations and responsiveness in rats bearing intracranial tumors induced by avian sarcoma virus
Authors: Roszman Thomas L. , Brooks William H. , Markesbery William R. , Aziz Gary J. , Bigner Darell D.
Published: May 2009

✓ The mitogenic responsiveness of peripheral blood lymphocytes obtained from Fischer 344 rats inoculated with avian sarcoma virus was studied. In addition, quantitative alterations in lymphocyte subpopulations were determined in these animals. Only peripheral blood lymphocytes from rats bearing astrocytomas had significantly diminished responses to concanavalin A when compared to control responses. The percentage of lymphocyte subpopulations detected in either the peripheral blood or spleen of tumor-bearing rats did not differ from values obtained with control rats. However, rats bearing astrocytomas had a marked decrease in the absolute number of the various lymphocyte subpopulations as a result of lymphopenia. Neither the sarcoma-bearing rats nor the virus-inoculated rats that did not develop tumors exhibited this lymphopenia. In addition, sera from rats bearing astrocytomas diminished the concanavalin A reactivity of spleen cells obtained from normal rats. The results of this study establish the avian sarcoma virus-induced rat astrocytoma model as a useful immunological parallel for the human disease.
Selective percutaneous thermocoagulation rhizotomy in essential glossopharyngeal neuralgia
Authors: Isamat Fabián , Ferrán Enrique , Acebes Juan José
Published: May 2009

✓ Percutaneous radiofrequency (rf) thermocoagulation of the inferior petrous ganglion of Andersch at the jugular foramen has been used to treat three patients with essential glossopharyngeal neuralgia. Two of these patients needed a second rf thermocoagulation, one within 1 week due to an incomplete result, and the other 8 months after the first procedure for recurrence of some neuralgic pain. Thus, a total of five rf thermocoagulations of the ganglion of Andersch have been performed. The patients are now pain-free and without significant side-effects. Deglutition and phonation have remained intact after each rf thermocoagulation. Glossopharyngeal selectivity was obtained by avoiding the risk of injury to the other nerves at the jugular foramen. The surgical technique involves precise x-ray control and constant monitoring of the blood pressure and electrocardiogram findings. Electrode misplacement or any spreading of current to the vagus nerve will be readily detected by bradycardia and hypotension during the physiological testing before a definite rf lesion takes place. The operative technique is described.
Cardiac catheters for diagnosis and treatment of venous air embolism
Authors: Bedford Robert F. , Marshall Wayne K. , Butler Albert , Welsh Joseph E.
Published: May 2009

✓ One hundred consecutive patients undergoing neurosurgical procedures in the seated position were monitored for venous air embolism with a Swan-Ganz pulmonary artery (PA) catheter, precordial Doppler ultrasound device, and continuous end-tidal CO2 (FETCO2) analysis. Simultaneous determinations of right atrial and pulmonary capillary wedge pressures were also performed during each operation. Although 80 episodes of air embolism were detected by changes in Doppler sounds, only 36 were associated with increased PA pressure, and only 30 developed a decrease in FETCO2. Changes in PA pressure and FETCO2 agreed closely (r = 0.86), and only marked changes were associated with systemic arterial hypotension. Air was recovered from the right atrium and PA only in small amounts (2 to 20 ml) during air embolism, although it was possible to aspirate large quantities of blood. Twenty-nine patients were found to have right atrial pressures that were higher than pulmonary capillary wedge pressures. Paradoxical air embolism from a probe-patent foramen ovale was possible in these patients, and one developed signs and symptoms of systemic air embolism postoperatively. We conclude that noninvasive monitoring with the combination of a precordial Doppler device and end-tidal CO2 analysis is satisfactory for rapid detection of clinically significant venous air embolism. The unique advantage of Swan-Ganz monitoring, however, is that it permits identification of patients who may sustain paradoxical air embolism, and that it differentiates the hemodynamic effects of brain-stem manipulation from those caused by air embolism.
Huge intraoral aneurysm presenting with dysphagia and dyspnea successfully treated by STA-MCA anastomosis and ICA ligation
Authors: Hori Tomokatsu , Terao Hideo , Eguchi Tsuneyoshi , Matsutani Masao
Published: May 2009

✓ A case of a huge, rapidly enlarging, intraoral carotid aneurysm, presenting with dysphagia and dyspnea, was successfully treated by a combination of extracranial-intracranial bypass and internal carotid artery ligation. This case is unusual in that a tendency to bleed was observed for about 3 weeks after the operation. This is thought to be related to a consumption coagulopathy associated with the aneurysm.
Rupture of an aneurysm into a parasellar epidermoid cyst
Authors: Sakaki Saburo , Matsuo Yoshihiko , Kuwabara Hiroto , Matsuoka Kenzo
Published: May 2009

✓ The association of various brain tumors with intracranial aneurysms is unusual. The present paper describes an extremely rare case of an intracranial epidermoid cyst associated with an aneurysm. The symptoms and the diagnostic problems are discussed briefly.
Fulminant postsurgical Bacillus cereus meningitis
Authors: Berke Eric , Collins William F. , Graevenitz Alexander Von , Bia Frank J.
Published: May 2009

✓ A 25-year-old woman presented with decreased level of consciousness, bilateral papilledema, and bitemporal hemianopsia. While receiving oxacillin prophylaxis, she underwent ventriculostomy and a transsphenoidal approach for the removal of a growth hormone- and prolactin-secreting adenoma of the pituitary. Within 4 days, fever, symptoms of meningitis, and marked cerebrospinal fluid (CSF) pleocytosis developed, associated with many large Gram-positive rods in the CSF, subsequently identified as Bacillus cereus.

This case emphasizes the potential for Bacillus species to cause serious disease following surgery, including meningitis after intracranial surgery. Meningitis may be severe, and organisms are often resistant to standard surgical prophylactic regimens, which might include penicillin or cephalosporin derivatives. Isolation of Bacillus species from the CSF requires evaluation; these organisms should not be dismissed as contaminants or “non-pathogens,” particularly when isolated from CSF of patients who have recently undergone neurosurgical procedures.
Intracerebral cyst due to ectopic choroid plexus
Authors: Azzam Narmer I. , Timperley Walter R.
Published: May 2009

✓ A case of supratentorial intracerebral cyst, containing ectopic choroid plexus, is discussed. The cyst had no communication with the ventricular system or subarachnoid space. The cyst wall was lined in part by flattened or cuboidal epithelium and in part by glia. Fronds of choroid plexus protruded into the cavity of the cyst in one part. The preoperative and postoperative computerized tomography scans are presented and the operative findings are discussed. The management of such cases is reviewed.
Catecholamine neurotransmitters, psychoactive drugs, and biological clocks
Authors: Axelrod Julius
Published: May 2009

✓ In his Cushing oration, the 1970 Nobel Laureate reviews the experimental history of the vital role which chemical agents play in the transmission of nerve impulses and the important functions of the brain. He reveals the intriguing steps in his own early involvement in the field of neurotransmitters. A beacon for neuroscientists of the future is his unique talent for not only looking, but seeing potentially significant clues.
Treatment of 54 traumatic carotid-cavernous fistulas
Authors: Debrun Gérard , Lacour Pierre , Vinuela Fernando , Fox Allan , Drake Charles G. , Caron Jean P.
Published: May 2009

✓ A series of 54 traumatic carotid-cavernous fistulas has been treated with detachable balloon catheters. The balloon was introduced through one of three different approaches: the endarterial route; the venous route through the jugular vein, the inferior petrosal sinus, and the cavernous sinus; or surgical exposure of the cavernous sinus; with occlusion of the fistula by a detachable balloon directly positioned in the cavernous sinus. Full follow-up review demonstrated that the carotid blood flow was preserved in 59% of cases. The most frequent complication was a transient oculomotor nerve palsy, which occurred in 20% of cases. In three cases where both the fistula and the carotid artery were originally occluded by the balloon, the superior portion of the fistula was later found not to be completely occluded, and these patients had intracranial ligation of the supraclinoid portion of the carotid artery. Three patients had hemiparesis, transient in two cases and permanent in the other. The results show that the fistula was totally occluded in 53 cases; in the one exception the patient became asymptomatic but had a minimal angiographic leak.
The role of extracranial carotid abnormalities in the genesis of cerebral aneurysms
Authors: Spallone Aldo , Cantore Gianpaolo
Published: May 2009

✓ The incidence of extracranial internal carotid artery (ICA) abnormalities, namely kinks, coils, and stenoses, was evaluated in a consecutive unselected series of 76 cases of single supratentorial saccular aneurysms submitted to bilateral carotid angiography. These patients were compared with a control group of 120 patients who had undergone either uni- or bilateral carotid angiography for causes other than cerebrovascular occlusive diseases or intracranial arterial aneurysms. Both groups had a total of 152 angiograms. Extracranial carotid abnormalities were significantly higher in aneurysm patients (p < 0.001). Arterial kinks and coils were seen on 42 of 152 angiograms in the saccular aneurysm group and 17 of 152 in the control group (p < 0.001); however, there was no significant difference regarding ICA stenoses (0.16 > p > 0.15). In the 76 aneurysm patients, abnormalities were mostly either located or more pronounced on the side opposite the aneurysm (in 22 as opposed to 11 on the same side, p < 0.004).

It is suggested that extracranial ICA anomalies have a role in the pathogenesis of intracranial arterial aneurysms, possibly by increasing the hemodynamic stress on the side opposite to the carotid lesion. The combination of the hydrodynamic theory, suggested by the present study, with other possible factors, might lead to a better understanding of the mechanism underlying development of human cerebral arterial aneurysms.
Changes in extracellular potassium concentration in cortex and brain stem during the acute phase of experimental closed head injury
Authors: Takahashi Hiroshi , Manaka Shinya , Sano Keiji
Published: May 2009

✓ A high potassium concentration ([K+]o) in brain tissue impedes neuronal activity, as observed in spreading cortical depression. Experimental studies were performed on mice and rats to determine the role of changes of [K+]o in cerebral concussion. In the first experiment, a 600 gm-cm impact was delivered to the vertex of the mouse skull. This impact induced arrest of spontaneous movement for 465 ± 55.9 seconds (mean ± SD), accompanied by apnea, bradycardia, and low-voltage electroencephalographic recordings (EEG). The injury was also frequently followed immediately by epilepsy. This impact induced an increase of cortical [K+]o from the control level of 4.1 ± 1.8 mM to 20–30 mM, with gradual recovery within 30 minutes to the control level.

In the second experiment, an impact of 9000 gm-cm was delivered to the midline parieto-occipital area of the rat and produced concussion-like phenomena similar to those elicited in mice. This level of trauma induced a significant increase of cortical [K+]o from the control level of 4.2 ± 0.8 mM to 20–50 mM in all of the rats, and also a significant increase of brain-stem [K+]o from 3.9 ± 0.6 to 20–30 mM in 73% of the rats. In these latter rats, the impact also induced apnea and a transient elevation of blood pressure, and resulted in low-voltage EEG recordings. In 23% of the rats in which [K+]o changes in the brain stem were not significant, the impact caused a transient reduction of blood pressure. The present study disclosed that an increase of [K+]o in the cerebral cortex and also in the brain stem is an important element in the phenomenon of concussion.
A study of glucocorticoid receptors in intracranial tumors
Authors: Yu Zhao-Ying , Wrange Örjan , Boëthius Jörgen , Hatam Ahmad , Granholm Lars , Gustafsson Jan-Åke
Published: May 2009

✓ Tissue samples from 20 patients with various intracranial tumors and one case of cerebral contusion were analyzed for the cytosolic glucocorticoid-receptor concentration using isoelectric focusing in slabs of polyacrylamide gel. It is pointed out that the clinical response to dexamethasone in brain edema associated with various intracranial lesions is, to some extent, parallel to the glucocorticoid-receptor concentration in these tumors. The findings in this investigation suggest that the cytosolic glucocorticoid receptor might be responsible for the initiation of a series of biochemical effects of steroids affecting brain edema. It is possible that the first step in eliciting a beneficial clinical response to dexamethasone in patients with brain tumors is the formation of a steroid-receptor complex in the peripheral parts of the tumor.
Prostaglandin metabolism in experimental cerebral vasospasm
Authors: Maeda Yukio , Tani Eiichi , Miyamoto Tsumoru
Published: May 2009

✓ Experimental cerebral vasospasm was produced in the canine basilar artery by an intracisternal injection of fresh autogenous arterial blood, and prostaglandins generated in spastic and nonspastic arteries were assessed by thin-layer chromatography. Prostaglandins synthesized in normal arteries were 6-keto-prostaglandin (PG)F1α, PGF2α, PGE2, and PGD2; 6-keto-PGF1α was the most abundant prostaglandin. The study of platelet aggregation suggested that prostacyclin (PGI2)-like activity was manufactured by the normal basilar artery. At 5 minutes after the intracisternal blood injection, no significant changes were evident in syntheses of prostaglandins generated by spastic artery. However, PGE2 synthesis was significantly increased in spastic artery 2 days after the intracisternal blood injection, and 6-keto-PGF1α and PGF2α synthesis and PGE2 synthesis were significantly decreased and increased, respectively, in spastic artery 6 days after the intracisternal blood injection. No significant changes were found in syntheses of 6-keto-PGF1α, PGF2α, and PGE2 manufactured by nonspastic arteries at any stage. Formation of thromboxane B2 was not detected in normal, spastic, or nonspastic arteries.
Hydrocephalus in cerebral cysticercosis
Authors: Lobato Ramiro D. , Lamas Eduardo , Portillo Jaime M. , Roger Ricardo , Esparza Javier , Rivas Juan J. , Muñoz Maria J.
Published: May 2009

✓ The cases of 11 patients with hydrocephalus secondary to cerebral cysticercosis are analyzed. Most of the patients had suffered from epilepsy before they developed hydrocephalic symptoms, and computerized tomography showed that infestation of the parenchyma coexisted with ventricular or cisternal colonization. In four cases, the parasitic vesicles compromised cerebrospinal fluid (CSF) flow in the ventricular system, resulting in internal hydrocephalus. Communicating hydrocephalus, caused by the presence of Cysticercus larvae in the basal cisterns (Cysticercus racemosus), or by the occurrence of a chronic basal meningitis, or both, developed in seven more patients. Changes in CSF pressure were related to the number and location of the cysts and to the leptomeningeal inflammatory reactions evoked by them. The majority of patients presented with a chronic and relatively normotensive hydrocephalus.

All patients except one had identifiable ventricular or cisternal Cysticercus larvae; these patients were treated with open removal of the cysts, and did well. However, most of them had impairment of CSF flow through the basal cisterns and required permanent CSF shunting. Communicating hydrocephalus due to leptomeningeal scarring was also successfully managed with extracranial shunting. Epilepsy was controlled with anticonvulsant therapy. Although good lasting results may be obtained with aggressive treatment of neurocysticercosis, patients are liable to relapse because surgery is only palliative in most instances.
Brain abscess: a review of 400 cases
Authors: Yang Shu-Yuan
Published: May 2009

✓ The author reviews 400 cases of brain abscess treated in China over 20 years. The commonest cause was chronic ear infection, with abscesses in the temporal lobe and cerebellum. Signs of increased intracranial pressure were present in most cases, localizing neurological signs in two-thirds, and clinical signs of infection in only 57%. The difficulties of early diagnosis may be considerable. Definitive diagnosis was dictated by the techniques available: when clinical features and ultrasound indicated a localized abscess, a burr hole and exploratory aspiration were used; otherwise, and in complicated cases, angiography or ventriculography were required. Antibiotics were given in full doses for an extended period. Aspiration was the initial treatment in 253 cases, with 22% mortality. Excision was the sole treatment in 128 patients, of whom 17.2% died. A further 76 patients underwent aspiration followed by excision; 25% of these patients died. There was no significant difference in mortality in these treatment groups. The most important predictor of outcome was the patient's condition when first seen. In 103 cases, signs of brain herniation were present; the mortality was 64% in these patients. In the 297 without herniation, mortality was only 8.4%. Early referral for specialist care, computerized tomography, correct choice and dosage of antibiotics, and the surgical methods in present use should make this a benign disease.
Stereotaxic reconstruction of the aqueduct of Sylvius
Authors: Backlund Erik-Olof , Grepe Arne , Lunsford Dade
Published: May 2009

✓ A stereotaxic technique has been developed to cannulate the cerebral aqueduct in patients with hydrocephalus resulting from occlusion of the aqueduct of Sylvius. Precise placement of a 15- to 20-mm long radiopaque prosthesis between the third and fourth ventricles can reestablish the normal cerebrospinal fluid (CSF) pathway. Since 1974, seven patients have undergone aqueductal reconstruction. The surgical goal in this series was to manage the hydrocephalus by creating and maintaining a patent aqueductal channel. The follow-up period ranged from 1.5 to 6.5 years. In four cases, aqueductal reconstruction alone resulted in control of the hydrocephalus, although two patients underwent revisions of their prosthesis. Three patients ultimately required shunts, despite initial symptomatic improvement after reconstruction. In these seven cases (13 stereotaxic procedures), no mortality and no significant operative morbidity were encountered. Although the technique is relatively simple to perform, technical difficulties remain. At present, no clinical or radiographic test adequately discerns the ideal candidate for stereotaxic aqueductal reconstruction. Four patients required stereotaxic revision because of malposition or malfunction of the prosthesis. This approach should be reserved for patients with a short aqueductal occlusion, and normal distal CSF pathways and dynamics. The rationale, technique, problems, and results of stereotaxic reconstruction are presented.
Detection of skull expansion with increased intracranial pressure
Authors: Heifetz Milton D. , Weiss Martin
Published: May 2009

✓ A technique is described which uses standard strain-gauge technology to detect skull expansion associated with increased intracranial pressure.
Modified skull tongs for cervical traction
Authors: Rimel Rebecca W. , Butler Albert B. , Winn H. Richard , Park Tae Sung , Tyson George W. , Jane John A.
Published: May 2009

✓ New skeletal tongs have been designed which offer a significant design advance over previously available models. The University of Virginia tongs combine the ease of application and increased weight-handling abilities of the Gardner-Wells tongs with the patient mobility allowed by the Crutchfield tongs.
Intravenous nitroglycerin for the treatment of chronic cerebral vasoconstriction in the primate
Authors: Frazee John G. , Giannotta Steven L. , Eugene Stern W.
Published: May 2009

✓ A primate model of chronic cerebral vasoconstriction is presented which closely approximates the human experience following subarachnoid hemorrhage. Treatment of the vasoconstriction with intravenous nitroglycerin produces a modest, but statistically significant, increase in the size of the most constricted vessels (11%, p < 0.02) when compared with a control infusion of normal saline. The significance of these experiments is discussed.
Reversal of experimental delayed cerebral vasospasm by angiotensin-converting enzyme inhibition
Authors: Gavras Haralambos , Andrews Philip , Papadakis Nicholas
Published: May 2009

✓ Delayed cerebral vasospasm is an important determinant of the clinical outcome after subarachnoid hemorrhage, but its prevention and treatment has met with limited success. Since cerebral arteries were found to be sensitive to the vasoconstrictor effect of angiotensin II, the possibility of angiotensin's contribution to this vasospasm was investigated. Delayed cerebral arterial spasm was documented angiographically 72 hours after introduction of blood in the subarachnoid space of dogs. Following injection of the angiotensin-converting enzyme inhibitor, teprotide, repeat cineangiograms at 30, 60, and 90 minutes demonstrated partial or total release of spasm of the basilar artery and its branches. It is concluded that angiotensin II participates in the delayed cerebral vasospasm after hemorrhage, and that angiotensin inhibition may release the spasm and prevent cerebral ischemia.
Relationship between visual evoked potentials and intracranial pressure
Authors: York Donald H. , Pulliam Morris W. , Rosenfeld John G. , Watts Clark
Published: May 2009

✓ The relationship between intracranial pressure (ICP) and latency of visual evoked potentials (VEP) was investigated in hydrocephalic patients with suspected shunt malfunction and in patients with severe head trauma. A positive correlation of increase in latency of wave N2 (normal latency 71 ± 9.2 msec) of the VEP with elevations in ICP was observed. A potential role for VEP in both the assessment of shunt function and the monitoring of patients with severe head injury is suggested by these findings.
Evaluation of endorphin content in the CSF of patients with trigeminal neuralgia before and after Gasserian ganglion thermocoagulation
Authors: Salar Giuseppe , Mingrino Salvatore , Trabucchi Marco , Bosio Angelo , Semenza Carlo
Published: May 2009

✓ The β-endorphin content in cerebrospinal fluid (CSF) was evaluated in 10 patients with idiopathic trigeminal neuralgia during medical treatment (with or without carbamazepine) and after selective thermocoagulation of the Gasserian ganglion. These values were compared with those obtained in a control group of seven patients without pain problems. No statistically significant difference was found between patients suffering from trigeminal neuralgia and those without pain. Furthermore, neither pharmacological treatment nor surgery changed CSF endorphin values. It is concluded that there is no pathogenetic relationship between trigeminal neuralgia and endorphins.
Apnea testing in the diagnosis of brain death
Authors: Ropper Allan H. , Kennedy Sean K. , Russell Lisa
Published: May 2009

✓ The absence of spontaneous respiration is a crucial determinant in the diagnosis of brain death, but standardized criteria for apnea testing have not been established. Guidelines are proposed based on the results of 51 apnea tests and associated physiological measurements. In patients who fulfilled all other conventional criteria for brain death, three exhibited non-repetitive back arching and shoulder shrugging when CO2 pressures reached 41 to 51 mm Hg during apnea testing. These respiratory-like movements were ineffective for ventilation and were not reproducible on the following day at the same or higher pCO2. The nature of these movements, evoked potential testing, and autopsy results suggest that they were not triggered by normal medullary centers, and that these patients were, in fact, brain-dead. In four other patients with severe brain damage sparing only the medulla, normal spontaneous ventilation resumed at CO2 pressures of 30 to 39 mm Hg (mean 34 mm Hg). High arterial oxygen tension raised this apnea point slightly, but spontaneous breathing always began at CO2 pressures lower than 40 mm Hg. This level is therefore adequate to stimulate medullary respiration in patients with severe brain damage who are not brain-dead. In brain-dead patients, pCO2 rises slowly during apnea (2.58 ± 0.85 mm Hg/min), in part because CO2 production is diminished (1.8 ± 0.23 ml/min/kg). These data allow estimation of a desired length of an apnea test and standardized interpretation of results.
Tentorial arteriovenous malformation presenting as an intracerebral hematoma
Authors: Fardoun Raeph , Adam Yves , Mercier Philippe , Guy Gilles
Published: May 2009

✓ A case of a tentorial arteriovenous aneurysm is reported in a 54-year-old man. This malformation, fed by branches of the external carotid artery, was drained exclusively by a parieto-occipital cortical vein. The rupture of this vein was responsible for the presenting intracerebral hematoma.
Traumatic exophthalmos due to an uncommon arteriovenous fistula without involvement of the cavernous sinus
Authors: Brada Gianni B. , Schramm Johannes , Kaernbach Achredt
Published: May 2009

✓ A case of traumatic exophthalmos due to an arteriovenous fistula between the middle meningeal artery and the veins at the base of the skull is reported. There was no involvement of the cavernous sinus. Embolization following selective transfemoral catheterization of the external carotid artery resulted in complete relief of the symptoms.