bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Glycine Administration on Canine Experimental Spinal Spasticity and the Levels of Glycine, Glutamate, and Aspartate in the Lumbar Spinal Cord
Authors: Smith J. E. , Hall P. V. , Galvin M. R. , Jones A. R. , Campbell R. L.
Published: May 2010

Twelve female mongrel dogs were made paraplegic by midthoracic spinal cord transection. Beginning at 9 weeks posttransection, either glycine (50 mg/kg) or saline was injected intramuscularly each day and the signs of spinal spasticity were assessed clinically. After treating the dogs for 3 weeks, we removed the lumbar enlargement of each dog and microdissected it into gray and white areas which we assayed for glycine, glutamate, and aspartate content. Some of the clinical signs of spasticity improved in the animals injected with glycine compared to the saline-injected controls. The content of glycine was significantly elevated in the central gray matter and ventral medial white matter of the glycinetreated dogs. The levels of glutamate were also significantly elevated in the central, lateral ventral, and medial ventral gray matter and in the dorsal lateral and ventral medial white matter of the glycine-treated dogs. The possible role of these segmental putative neurotransmitters in spinal spasticity is discussed.
Ossification of the Posterior Longitudinal Spinal Ligament in Association with Anterior Longitudinal Ligament Ankylosing Hyperostosis
Authors: Rappaport Z. H. , Rovit Richard
Published: May 2010

A case of ossification of the posterior spinal longitudinal ligament in association with anterior ankylosing hyperostosis is presented, with a review of the relevant literature. Improvement followed laminectomy. Evaluation of this entity by computerized tomography is demonstrated.
Calvarial Hemangioendothelioma with Intracranial Hemorrhage
Authors: Maroon Joseph C. , Haines Stephen J. , Phillips John G.
Published: May 2010

A case of a hemangioendothelioma of the occipital bone that presented clinically as an acute epidural hematoma is reported. The literature regarding this rare bone tumor is reviewed. The treatment of choice seems to be wide surgical excision, but life-threatening hemorrhage may occur due to extreme tumor vascularity. The role of radiotherapy remains uncertain.
Chondroma of the Spine in a Newborn Infant
Authors: Waga Shiro , Tochio Hiroshi , Sakakura Makoto
Published: May 2010

We report a newborn infant with a chondroma of the spine covered by a large lipoma. The child had no neurological deficit. Presenting as a tumor of the back, the chondroma was successfully excised. A review of the pertinent literature emphasizes the rarity of this lesion.
Radiological Assessment of Intramedullary Spinal Cord Lesions
Authors: Cusick Joseph F. , Haughton Victor M. , Williams Alan L.
Published: May 2010

Gas myelography performed in the modified two-step technique has proven to be effective in defining the character and extent of intramedullary spinal cord lesions. A classification of four types of spinal cord abnormalities based primarily on the hydrodynamic changes induced during gas myelography assists in determining the need for specific neuroradiological and surgical procedures. The comparative value of other myelographic and pneumoencephalographic techniques is discussed.
Hypovolemia in Patients with Subarachnoid Hemorrhage
Authors: Maroon Joseph C. , Nelson Paul B.
Published: May 2010

Red blood cell mass and total blood volume were significantly decreased in 15 nonselected patients with subarachnoid hemorrhage. Possible causes of the contracted blood volume include bedrest, supine diuresis, pooling in the peripheral vascular beds, negative nitrogen balance, decreased erythropoiesis, and iatrogenic blood loss. The data support the use of intravascular volume expansion with red blood cells and colloid in the prevention and treatment of ischemic complications associated with ruptured intracranial aneurysms.
Toxic Substances in Spinal Cord Injury
Authors: Stein Sherman C. , Cracco Roger Q. , Farmer Peter , Kiest Curtis A.
Published: May 2010

Several investigators have implicated norepinephrine and other toxic substances released in the region of a spinal cord injury in the genesis of the progressive pathological and clinical changes that follow spinal trauma. To test this hypothesis. we subjected cats to T-10 to T-12 laminectomy and monitored epidural spinal evoked potentials from sciatic nerve stimulation. The spinal subarachnoid space was perfused with normal saline, with norepinephrine solution, or with heparinized autologous blood or the pial surface of the spinal cord was exposed to macerated gray matter taken from the upper cervical cord. During 1- to 2-hour exposure periods, we noted no significant changes in the base line spinal evoked potentials. In another series of cats, we have shown that norepinephrine perfused over the spinal cord in this manner diffuses rapidly into the subpial white matter. Therefore, its failure to affect spinal evoked potentials does not represent a failure to penetrate the spinal cord. Putative toxins must originate either in extravasated blood or damaged neural tissue in the region of the spinal cord injury. The failure of ascending spinal tracts to react to blood or cord tissue in our experiment suggests that toxins are not involved in the spinal cord dysfunction that occurs soon after injury.
Salvage of a Nonfunctional Superficial Temporal-Middle Cerebral Artery Anastomosis
Authors: Boone Stephen C. , Samson Duke S.
Published: May 2010

This technical note describes a means of converting a nonfunctioning end-to-side superficial temporal-middle cerebral artery anastomosis to a functional end-to-end anastomosis.
Prognosis of Patients with Severe Head Injury
Authors: Jennett B. , Teasdale G. , Braakman R. , Minderhoud J. , Heiden J. , Kurze T.
Published: May 2010

The relationship between clinical features of brain dysfunction in the first week after severe head injury and outcome 6 months later has been analyzed for 1000 patients. Depth of coma, pupil reaction, eye movements, and motor response pattern, and patient age prove to be the most reliable predictors. The degree of brain dysfunction changes markedly soon after injury, and more reliable predictions of outcome result when assessment is based on the best level of functioning recorded in each early epoch. Predictions based on very early assessment are, therefore, often unduly pessimistic. Individual predictions of outcome, based on a large data bank, provide a powerful tool for assessing the relative efficacy of alternative treatments.
Primary Wire Mesh Cranioplasty in Flap Infections
Authors: Koslow Maxim , Ransohoff Joseph
Published: May 2010

Primary wire mesh cranioplasty was performed in five patients at the time of removal of an infected frontal or frontotemporal bone flap or cranioplasty plate. No recurrent infections have occurred, with follow-up extending to 46 months. The pre- and postoperative management and rationale for this procedure are discussed in light of available data regarding bacterial interactions with alloplastic materials.
Cerebrospinal Fluid Markers in Central Nervous System Metastases from Testicular Carcinoma
Authors: Sundaresan Narayan , Vugrin Davor , Nisselbaum Jerome , Galicich Joseph H. , Cvitkovic Esteban , Schwartz Morton K.
Published: May 2010

Serum values of alpha-fetoprotein (AFP) and human chorionic gonadotrophin (HCG) have been used to monitor disseminated testicular carcinoma. Serial measurements of these markers have been used to monitor the response to therapy, to follow the progress of disease, and to detect subclinical recurrences. With increasingly effective chemotherapy for systemic disease, central nervous system (CNS) metastases in testicular carcinoma are becoming increasingly important as a cause of treatment failure. Cerebrospinal fluid (CSF) values of AFP and HCG seem to be important ancillary aids in the neurosurgical management of CNS metastases from testicular cancer. Our preliminary experience with three cases suggests that these CSF markers (plus computerized tomographic scanning) should be evaluated in patients with this disease.
Ultrasonic B-Scan Echoarteriographic Imaging of Experimentally Induced Thrombi in Dogs
Authors: Sekhar Laligam N. , Wasserman Jack F. , van der Bel-Kahn Johanna , Olinger Charles P.
Published: May 2010

Ultrasonic echoarteriography is a noninvasive method of visualizing extracranial arteries in health and disease. The realtime echoscanning device developed at the University of Cincinnati utilizes a 5-MHz (center frequency) pulse-echo imaging system. B-mode pictures of the tissues studied are obtained and displayed on a video screen, real-time operation being provided by the scanning mechanism operating at 30 frames per second. In our experiments internal arterial damage produced by surgically scraping the intima induced experimental thrombosis in nine carotid and three femoral arteries in dogs. Where pathologically demonstrated, the thrombi were demonstrated by ultrasonic echoarteriography in every instance. Echoarteriography seemed more sensitive than contrast arteriography in the detection of a partially occlusive thrombus.
Resection of Multiple Nocardial Brain Abscesses
Authors: Rosenblum Mark L. , Rosegay Harold
Published: May 2010

We present a case of multiple brain lesions in which the preoperative computerized tomographic (CT) scan suggested the presence of brain abscesses rather than metastatic tumors. The patient presented with symptoms of left frontal and right cerebellar mass lesions, confirmed by carotid and vertebral arteriography and a radionuclide brain scan. A CT scan revealed multiple contiguous ring-enhancing lesions of various sizes at both sites. With the exception of a prior mild pulmonary infection, no findings suggested underlying malignancy, immunosuppression, or medical illness. We based our decision to administer antibiotics preoperatively on the presumed presence of abscesses. We found and totally removed two multiloculated abscesses during one operation and initiated sulfa drug therapy (sulfisoxazole) immediately after identification of the Nocardia organism. The patient experienced no postoperative complications and at 6-months follow-up is clinically free of disease.
Extracranial-Intracranial Arterial Bypass to a Single Branch of the Middle Cerebral Artery in the Management of a Traumatic Aneurysm
Authors: Spetzler Robert F. , Owen Michael P.
Published: May 2010

This case required the clipping of a single branch of the middle cerebral artery for the treatment of a traumatic aneurysm. To ensure an adequate blood supply distal to the occlusion, we anastomosed the superficial temporal artery to that branch of the middle cerebral artery (MCA) distal to the aneurysm. Despite the low flow required to irrigate only one branch of the MCA, the anastomosis remained patent. This case demonstrates the feasibility of performing small vessel anastomoses in spite of low flow demand.
Computerized Tomographic Scan and Gunshot Wounds of the Head
Authors: Cooper Paul R. , Maravilla Kenneth , Cone Jeffrey
Published: May 2010

abstract

The authors document their experience with the computerized tomographic (CT) scanner for evaluating gunshot wounds of the head. Only those patients who were considered to be operative candidates and who were neurologically stable were scanned. In the postoperative period, patients who were not scanned preoperatively and those whose condition did not improve were also scanned. In the preoperative period the CT scanner is useful for identifying and localizing missile tracks, bony and metallic fragments, intra- and extraparenchymal hematomas, intracranial air, and brain swelling. In the postoperative period the CT scanner may demonstrate retained bone fragments, edema, brain abscess, and intracranial air. The limitations of the CT scan in evaluating gunshot wounds include an inability to define vascular lesions such as traumatic aneurysms and post-traumatic spasm. Metallic scatter from missile fragments may render certain CT cuts uninterpretable. In addition, the CT scan may appear minimally abnormal in spite of immediate and irreversible injury caused by a shock wave transmitted to brain stem structures. The CT scanner has superceded angiography as a diagnostic tool for evaluating gunshot wounds of the head because it is noninvasive and rapid, allows visualization of the entire head, can resolve very small lesions that produce little or no mass effect, can help to determine the nature of intracranial lesions, and may quantitate the amount of hemorrhage and edema. Because it enables physicians to visualize intracranial structures in three dimensions, the CT scan may precisely define missile tracks and contiguous lesions in a manner not heretofore possible with other diagnostic modalities. Thus, it is invaluable for the rational planning of surgical therapy.
Ventricle to Sagittal Sinus Shunt for Hydrocephalus
Authors: Hash Cecil J. , Shenkin Henry A. , Crowder Leonard E.
Published: May 2010

abstract

A technique of shunting the lateral ventricle to the superior sagittal sinus is described. It has been used in 36 adult patients; infection occurred in 2 patients (5.6%), and 2 patients required shunt revision (5.6%). The outcome of 18 patients with high pressure hydrocephalus could be validly evaluated, and successful control was achieved in 15 (83%). One of the 3 failures could have been avoided because shunting was undertaken before the ventricular fluid had cleared of blood. Four patients with normal or low pressure hydrocephalus were treated; only 1 had a successful result. This technique is suitable for patients with high pressure hydrocephalus and is of particular value in very ill or debilitated patients because of the rapidity with which it can be performed under local analgesia. Its use in normal or low pressure hydrocephalus must still be evaluated. In any event, the sagittal sinus is certainly a feasible alternate receptor site for ventricular shunting.
Results of Surgical Lysis of Lumbar Adhesive Arachnoiditis
Authors: Wilkinson Harold A. , Schuman Nancy
Published: May 2010

abstract

From a series of 681 patients with lumbar disc disease treated between 1966 and 1978, 17 patients required surgical lysis of lumbar adhesive arachnoiditis, 8 having initially been operated upon by another surgeon. All patients had severe pain as a predominant feature, with pain being bilateral in 9 patients. Pain was the only major symptom in 3; the other 14 exhibited varying combinations of progressive neurological dysfunction. Three patients developed late symptoms after trauma, 8 to 21 years after back surgery. At operation, multisegmental arachnoiditis was found in 5 patients and anular or subtotal adhesions were found in 12. Complete lysis could not be obtained in 4 patients. Fourteen patients were treated with steroids at the time of operation. Follow-up after lysis was less than 1 year for 5 patients but averaged 4.8 years for the remaining 12. During the 1st year after operation, 76% experienced improvement in pain (35%, good to excellent), and 71% experienced improvement in neurological status. Follow-up after at least 1 year revealed 50% still enjoying pain relief (25%, good to excellent) and 45% experiencing neurological improvement. Pain relief persisted in 4 of 5 patients followed 5 years or more. The etiological role of myelography and lumbar disc surgery in arachnoiditis has probably been over-rated. Arachnoiditis may be symptomatic or asymptomatic and may mask other, treatable lumbar lesions. More frequent intradural exploration for discrepancies between operative and myelographic findings might reveal, and benefit, more cases of spontaneous arachnoiditis mimicking lumbar disc disease.
Combined Supratentorial and Infratentorial Exposure for Low-lying Basilar Aneurysms
Authors: Major David L. Kasdon , Stein Bennett M.
Published: May 2010

abstract

Details of an operative approach for low-lying basilar aneurysms utilizing a combined supratentorial and infratentorial exposure with tentorial section are presented. This approach permitted the successful clipping of aneurysms of the caudal basilar artery in both of the cases presented. The advantages of this approach over the transclival, posterior fossa, and subtemporal approaches are discussed
Radiofrequency Coagulation of the Petrous Ganglion in Glossopharyngeal Neuralgia
Authors: Lazorthes Yves , Verdie Jean-Claude
Published: May 2010

abstract

In this communication the authors describe a method for the surgical treatment of glossopharyngeal neuralgia by percutaneous radiofrequency coagulation of Andersch's petrous ganglion. The report is of the initial results in 12 cases, including 1 case of primary glossopharyngeal neuralgia. The usual indication for the procedure is intractable pain due to local neoplasia of the oral area. At the time of operation complementary radiofrequency coagulation of both the gasserian ganglion and the cervical radicular nerves can also be carried out.
Anatomical Study of a Posterior Cerebral Lesion Producing Dyslexia
Authors: Van Buren J. M.
Published: May 2010

abstract

After an “occipital lobectomy” that resulted in a severe dyslexia and a moderate dysgraphia-dyscalculia, anatomical study showed damage to the posterior extremity of the angular gyrus and degeneration in the posteroinferior pulvinar. This is in contrast to an earlier case that had degeneration in the anterosuperior pulvinar associated with a small anterior temporoparietal infarct and a well-documented receptive-expressive aphasia. However, the role of the pulvinar in speech function remains uncertain. The surgeon should be aware of the short distance between the angular gyrus and both the midline and the occipital pole because a lesion here during an “occipital lobectomy” produces a distressing and durable speech impairment.
Assessment of the Postoperative Course of Excised Brain Abscess by Computerized Tomography
Authors: Feely Michael P. , Dempsey Peter J.
Published: May 2010

abstract

We present two patients with brain abscess who underwent complete excision with a satisfactory clinical outcome although serial computerized tomography (CT) scans in the early postoperative period seemed to indicate a large residual abscess in each case. We recommend treatment based on the clinical course rather than the CT scan appearance, indicate that earlier reports on this topic may be misleading, and suggest an explanation for these findings.
Bilateral Interhemispheric Subdural Hematomas
Authors: Major David L. Kasdon , Magruder Michael R. , Stevens Edwin A. , Paullus Wayne S.
Published: May 2010

abstract

Interhemispheric subdural hematomas are rare. Bilateral interhemispheric subdural hematomas in a patient with a ventriculoperitoneal shunt for hydrocephalus were diagnosed by computerized tomographic (CT) scan after mild head trauma. The value of CT scanning, the clinical presentation and treatment, and a review of the literature are presented.
Cervical Dermal Sinus and Intramedullary Spinal Cord Abscess
Authors: Bean James R. , Walsh John W. , Blacker Martin H.
Published: May 2010

abstract

Congenital dermal sinuses in the cervical region are rare. A case report is presented in which the persistent anomaly led to formation of an intramedullary spinal cord abscess. The clinical presentation, radiological diagnosis, and surgical management are discussed.
Fracture and Complete Dislocation of the Thoracic or Lumbosacral Spine
Authors: Jackson Richard H. , Quisling Ronald G. , Day Arthur L.
Published: May 2010

Severe fracture/dislocation of the thoracic (T) or lumbar (L) spine is usually associated with complete neurological dysfunction below the level of injury. Three cases of severe spinal fracture/dislocation are presented in this report. Two of these patients suffered only partial neurological deficit, which improved after open reduction, internal fixation, and bone fusion. Severe fracture/dislocation of the T or L spine may be quite obvious on lateral roentgenograms. Occasionally, however, the fracture site may be obscured by the overlying shoulders, hips, or soft tissues. If no lateral displacement is evident on anteroposterior (AP) films, a false impression of normal alignment may be given, as was the case in two of our patients. A careful interpretation of the AP view will provide the diagnosis in such cases. The subtle AP radiographic changes suggesting fracture/dislocation of the T or L spine are detailed. The mode of injury, physical findings, prognosis, and surgical treatment of such severe injuries are also briefly reviewed.
Planned Intracranial Revascularization before Proximal Ligation for Traumatic Aneurysm
Authors: Fein Jack M. , Flamm Eugene
Published: May 2010

Proximal internal carotid artery aneurysm may be treated successfully with internal carotid artery ligation. If this is not tolerated because of ischemic insufficiency, an alternative strategy is possible. This consists of extracranial-intracranial bypass to increase the collateral circulation and perfusion pressure in the ipsilateral cerebral hemisphere before ligation. Experience with two cases is presented to show that such an approach is feasible.
Carcinoma Associated with Lipomeningocele
Authors: Marini Giovanni , Bollati Angelo , Galli Giuseppe , Gandolfini Massimo
Published: May 2010

We report the case of a 41-year-old man with an epidermoid carcinoma that had developed on a meningocele with a fistulous tract that chronically drained cerebrospinal fluid. After a review of the literature, we discuss the cause of this rare occurrence. We think that the recurrent discharge of spinal fluid (never complicated by meningitis) may have caused a chronic irritation of the tissues and then the delayed development of a carcinoma, which is similar to a case found in the literature. In our case there was a “flow” of carcinomatous cells along the fistula, which entered the meningocele, invading the subdural space as far as the peduncle. Our patient, who had a benign lesion (meningocele), came under neurosurgical care only after the lesion had degenerated. The malignant degeneration of such a benign lesion emphasizes the need for surgical treatment as soon as possible.
Intramedullary Lymphoma of the Spinal Cord
Authors: Fisher Robert G.
Published: May 2010

A rare case of intramedullary lymphoma of the cervicothoracic portion of the spinal cord is recorded. There was rapid destruction of spinal cord function and no form of therapy aided in neurological recovery or survival.
Bilateral Acute Subdural Hematomas Undiagnosed by Computerized Tomography
Authors: Gudeman Steven K. , Young Harold F. , Miller Douglas J. , Becker Donald P.
Published: May 2010

The authors describe a case of bilateral acute subdural hematomas undiagnosed by computerized tomography of the brain. The role of cerebral angiography in the management of the head-injured patient is discussed.
The Genesis and Significance of Delayed Traumatic Intracerebral Hematoma
Authors: Gudeman Steven K. , Kishore P. R. S. , Miller Douglas , Girevendulis Alex K. , Lipper Maurice H. , Becker Donald P.
Published: May 2010

During a 34-month period, 12 cases of delayed traumatic intracerebral hematoma (DTICH) were diagnosed among 162 consecutive prospectively studied patients admitted to the Medical College of Virginia with severe closed head injuries. All patients were unresponsive to command and unable to utter formed words at the time of admission. The interval from injury to diagnosis of DTICH by computerized tomography (CT) was within 48 hours in 11 of the 12 cases. Six patients had no decompressive surgery before the development of the lesion. Four patients had undergone decompressive surgery and then developed DTICH on the contralateral side. Two patients developed lesions in the vicinity of the operative site that were thought not to be the result of operation. The development of DTICH was not heralded by neurological deterioration nor by elevation of intracranial pressure. Eleven of the 12 patients had suffered a secondary hypoxic insult soon after the head injury. We suggest that the CT appearance of DTICH is likely to represent hemorrhage into an existing traumatized area and is an epiphenomenon rather than a cause of severe primary and secondary brain damage.
Hysteresis in the Relationship between Cerebrospinal Fluid Absorption Minus Formation and Cerebrospinal Fluid Pressure in the Dog
Authors: Chandler William F. , Zwetnow Nicolaus N. , LÖfgren Jan
Published: May 2010

In this study the difference between cerebrospinal fluid (CSF) absorption and formation (A - F) was measured as a function of CSF pressure in the living and dead dog. We determined this relationship between A - F and CSF pressure during both increasing and decreasing CSF pressures. A hysteresis effect was identified in 78% of living animals, but was not seen in the dead animals. This suggests that the mechanism of CSF absorption in the living dog is nonpassive and pressure-sensitive.
Tension Pneumocephalus of the Cranial Subdural Space
Authors: Black Peter McL. , Davis James M. , Kjellberg Raymond N. , Davis Kenneth R.
Published: May 2010

A case of subdural tension pneumocephalus is presented. Computerized cranial tomography permitted rapid diagnosis including localization of the air, thus facilitating prompt treatment. Tension pneumocephalus should be considered in a patient with a cerebrospinal fluid drainage device who deteriorates after craniotomy.
Cervical Spondylotic Radiculopathy Producing Motor Manifestations Mimicking Primary Muscular Atrophy
Authors: Dorsen Michael , Ehni George
Published: May 2010

Cervical radiculopathy unaccompanied by pain or sensory disorder but manifested only by paresis, atrophy, fasciculation, and reflex loss is unusual. Three such cases are presented. Considerable diagnostic difficulty may arise in distinguishing patients presenting with these features from those who have primary motor neuron disease. Two additional case reports demonstrate that this distinction is not always possible. Diagnosis, management, and prognosis are discussed. Differentiation between motor neuron disease and spondylosis will avert needless surgery in the former group and will result in beneficial, sometimes curative surgery in the latter group.
Acute Hyperesthesia after Spinal Trauma
Authors: Mullen John B.
Published: May 2010

Four cases of acute hyperesthesia after spinal trauma are presented. An attempt is made to characterize the natural history of this syndrome. In the three cases with truncal sensory aberration, hyperesthetic zones developed only anteriorly. All four patients demonstrated spontaneous relief of pain within 2 weeks after injury. The pain was modified by transcutaneous stimulation in one case and by l-dopa in another case. It is suggested that the “lesion” responsible for the hyperesthetic response is partial damage to dorsal root fibers at a point medial to the dorsal root ganglion.
Intraventricular Fiberscopic Observations in Adult Hydrocephalic Patients
Authors: Takei Yoshio , Pearl Gary S. , Fresh Babson C. , Fleischer Alan S. , Payne Nettleton S. , Tindall George T.
Published: May 2010

A flexible ventriculofiberscope was used to diagnose intraventricular pathological conditions in eight adult hydrocephalic patients. In each case the entire procedure was recorded on videotape for documentation, review, and teaching. Four representative cases are presented to illustrate the use and value of this technique.
Temporary Microvascular Clips
Authors: Dujovny Manuel , Kossovsky Nir , Laha Ranjit K. , Leff Louis , Wackenhut Norman , Perlin Alfred
Published: May 2010

Selected commercially designated temporary clips (Acland, Biemer, Kleinert-Kutz, Variangle, and Yasargil) were applied for 1 hour to rat common carotid arteries. Scanning electron and light microscopic studies revealed varying degrees of endothelial damage. The authors believe that further improvements are needed in the design of temporary clips.
Traumatic False Aneurysm and Carotid-Cavernous Fistula
Authors: Lister Richard J. , Yonas Howard , Sypert George W.
Published: May 2010

Severe head injury with resultant basilar skull fracture is the most common etiology for traumatic false aneurysm of the cavernous carotid artery and for traumatic carotid-cavernous fistula. We present a case of false aneurysm and fistula that occurred as a complication of sphenoidotomy, fortunately a rare etiology of these two serious problems. Because of the current resurgence of trans-sphenoidal surgery, it is of utmost importance that all neurosurgeons possess an accurate and detailed knowledge of the anatomy of the carotid artery and its intracavernous route.
Use of Metrizamide Computerized Tomographic Cisternography in the Evaluation of Patients with Malignant Glioma for Immunotherapy
Authors: Neuwelt Edward A. , Diehl Jan T. , Hill Suellen A. , Maravilla Kenneth R.
Published: May 2010

The communication between the subarachnoid space and the surgically created tumor cavity in glioma patients was evaluated by metrizamide cisternography. It was necessary to know the presence or absence of such a communication to determine the route of administration of autologous lymphocytes as a form of immunotherapy. The contrast injections were made either into the spinal subarachnoid space or directly into the tumor cavity. The presence of communication was demonstrated and followed by computerized tomographic (CT) scanning. The results were also corroborated by comparing the white cell counts in the fluid from the tumor cavity and the spinal subarachnoid space 24 hours after autologous lymphoid cell infusion. In only two of seven patients was a communication present. In the five patients without a communication, the blocks were at the tentorial hiatus (one patient), due to a nonpatent subarachnoid space over the cerebral convexity (two patients), and the result of adhesions at the pial margin of the tumor cavity (three patients). In addition, certain limitations in the use of computerized tomography in the evaluation of glioma patients are demonstrated. These problems include the effects of steroids on tumor size, the poor correlation between “enhancement” on CT scan and tumor recurrence, and the difficulty of differentiating metrizamide and hemorrhage by CT scan in the immediate postoperative period.
Spontaneous Subdural Hematoma of Arterial Origin
Authors: Byun Hang S. , Patel Pratap P.
Published: May 2010

Two cases of nontraumatic subdural hematoma of arterial origin in otherwise healthy individuals are described. The literature is reviewed, and a possible mechanism is postulated.
Brain Metastasis
Authors: Black Perry
Published: May 2010

An overview of brain metastasis with respect to the pathological, diagnostic, and therapeutic aspects is presented. Management is almost always palliative, with cure being a rare exception. Evaluation of various therapeutic modalities—radiation, chemotherapy, or surgery—has been confounded by a lack of controlled, randomized studies whereby the relative benefit of the respective modalities can be assessed objectively. Despite these limitations, some progress is being made in the identification of those patients for whom therapy is likely to be of benefit. Apart from the use of steroids to control cerebral edema, radiotherapy is currently the most commonly employed therapeutic modality for cerebral metastasis. It is the treatment of choice for multiple intracranial metastases and it affords temporary improvement in neurological symptoms in about 60% of patients. For solitary metastases, combined therapy—surgical excision followed by whole brain radiotherapy—has been shown to result in a better quality and longer duration of survival than either modality alone. Except for patients who are terminally ill, aggressive treatment seems warranted, inasmuch as therapeutic results have been improving steadily over the years. Neither chemotherapy nor immunotherapy has been shown to be of benefit in the management of cerebral metastasis. An exception is choriocarcinoma, which responds well to a combination of radiation therapy and chemotherapy. Although the prognosis for meningeal carcinomatosis is poor, improved survival may be achieved by a combination of chemotherapy and radiotherapy. These are recommended guidelines for surgical intervention, usually followed by radiotherapy: (a) In general, surgical excision is recommended only for patients with relatively superficial, solitary lesions. It is reasonable, however, to consider the excision of a metastatic lesion that is immediately life-threatening or incapacitating, even though one or more other metastatic brain lesions may be present. This may be extended to the removal of multiple metastatic brain tumors if they are surgically accessible. (b) The second consideration is whether the primary tumor can or has been treated or if the primary tumor will permit reasonably long survival. (c) There should not be metastases elsewhere in the body, although their presence should not categorically exclude the patient as a surgical candidate. (d) The patient's general condition should be satisfactory. (e) Operation is recommended if the diagnosis of the intracranial lesion is uncertain. (f) A shunt should be considered for treatment of hydrocephalus secondary to obstruction of the cerebrospinal fluid pathway by tumor or edema.
Needle Biopsy under Computerized Tomographic Control
Authors: James Hector E. , Wells Michael , Alksne John F. , Wickbom Ingmar , Siemers Paul , Brahme Folke , Rosenberg Jay
Published: May 2010

Thirteen patients with intracranial lesions were submitted to a twist drill needle biopsy under computerized tomographic (CT) control, with sedation and local anesthesia. (The patients' ages ranged from 12 to 81 years.) The final diagnoses were glioblastoma in 7 patients and 1 case each of anaplastic astrocytoma, low grade astrocytoma, thrombosed arteriovenous malformation, cerebral infarct, 3rd ventricular epidermoid, and degenerative disease of the brain. Definitive diagnosis was obtained in all but 2 patients with this technique. Appropriate therapy was subsequently instituted in 11 patients without further operation. Transiently increased weakness of the previously affected limbs was the only untoward effect (4 patients). Intracranial hematoma after this procedure was seen in 1 patient in this series, as detected by the postprocedure CT scan, but there was no change in the clinical course. All patients were treated with dexamethasone for 24 to 48 hours before and for several days after the procedure to avoid decompensation of intracranial dynamics because of edema. The procedure, including appropriate level CT scans of the lesion area, was performed in approximately 1 hour in all patients.
Treatment of Acute Focal Cerebral Ischemia with Intermittent, Low Dose Mannitol
Authors: Little John R.
Published: May 2010

The object of this investigation was to study the effects of intermittent, low dose mannitol therapy on conscious cats after acute left middle cerebral artery (MCA) occlusion. A simple implanted device was applied to the proximal left MCA of 40 adult cats using microsurgical techniques. In the acute experiments, 10 cats were untreated and 10 cats received mannitol (0.5 g/kg intravenously) immediately before occlusion and again 3, 6, and 9 hours later. They subsequently underwent intra-arterial perfusion with colloidal carbon and buffered paraformaldehyde 12 hours after occlusion. The plasma osmolality immediately before perfusion was 316 ± 2 (SD) milliosmoles in untreated cats and 331 ± 5 milliosmoles in treated cats. Gross swelling, impaired carbon filling, and breakdown of the blood-brain barrier (BBB) to fluorescein were seen in the left MCA territory of 8 untreated cats and 1 treated cat. The mean percentage of gray matter cross sectional area where severe ischemic neuronal alterations predominated was 45 ± 12% in untreated and 14 ± 16% in treated cats (p < 0.01). The mean capillary luminal diameter in the left sylvian cortex was 4.5 ± 1.0 μ in untreated cats (control, 6.5 ± 1.0 μ) and 5.5 ± 1.0 μ in treated cats. In the subacute experiments, 10 cats were not treated and 10 cats received mannitol as in the acute experiments. The cats were killed with a large bolus of sodium pentobarbital 48 hours after left MCA occlusion. Gross swelling and breakdown of the BBB were less severe in treated cats. The mean cross sectional area of infarcted tissue was 55 ± 12% in untreated cats and 33 ± 21% in treated cats (p < 1.0). The findings of this study indicate that intermittent, low dose mannitol therapy delays the onset of ischemic cerebral injury and may reduce the size of the eventual infarct or convert a potential infarct into a so-called “transient ischemic attack.”
Saccular Aneurysm Associated with Fenestrated Basilar Artery
Authors: Becker Dennis H. , Hamilton Richard D.
Published: May 2010

A case of saccular aneurysm associated with a fenestrated proximal basilar artery is presented. The aneurysm projected anteriorly, superiorly, and slightly to the left. Via a right suboccipital approach, the aneurysm was clipped with preservation of all vessels. The only postoperative deficit is a resolving dysphonia.
Rupture of Intracranial Aneurysm Causing Acute Subdural Hematoma, Intratemporal Hematoma, and Decerebration, with Survival
Authors: Ryan Edward P.
Published: May 2010

The author reports a case of intracerebral and subdural hematomas of acute onset secondary to rupture of an aneurysm. The patient was in a state of advanced decerebration and was breathing spontaneously although irregularly. There was a gratifying response to prompt neurosurgical intervention.
Eosinophilic Granuloma Mimicking a Pituitary Tumor
Authors: Goodman Richard H. , Post Kalmon D. , Molitch Mark E. , Adelman Lester S. , Altemus L. Reed , Johnston Hugh
Published: May 2010

The authors present the case report of a patient in whom hypopituitarism, diplopia, and visual field defects were due to eosinophilic granuloma. Radiographic studies were suggestive of a pituitary tumor and subsequent histological evaluation showed replacement of the anterior pituitary by histiocytic cells. Eosinophilic granuloma should be included in the differential diagnosis of an intrasellar mass.
Spinal Metastasis
Authors: Black Perry
Published: May 2010

An overview of the current status of various aspects of spinal metastasis, including pathology, diagnosis, and management, is presented. The cell type of the tumor, particularly with reference to its radiosensitivity, seems to be positively correlated with treatment outcome, regardless of the treatment modality. Because pretreatment neurological status also seems to influence prognosis, early identification of spinal involvement in patients at risk is important; therefore, a high index of suspicion in patients known to have cancer is necessary. The most useful warning of impending spinal cord or nerve root compression is spinal or radicular pain, which usually precedes neurological deficit by days to years. An aggressive diagnostic evaluation of pain symptoms is therefore warranted; this should include plain spine films and, in questionable cases, radioisotope bone scan. Myelography should also be considered in any cancer patient with persistent spinal or radicular pain, even in the absence of neurological deficit and certainly if there is any neurological impairment. Therapeutically, radiation and surgery continue as the mainstays of management, whereas steroids and chemotherapy serve as adjuvants. The guidelines for management recommended in this paper are to be viewed as tentative because the ideal treatment for spinal metastasis has not been established. The proposed guidelines are based on an analysis of retrospective studies that suggest that radiotherapy should be the primary mode of treatment and that surgery should be reserved for situations in which radiotherapy fails or where there is bony compression or spinal instability. Cases are presented to illustrate the application of these guidelines.
Scanning Electron Microscopic and X-ray Energy Spectrographic Analysis of the Inner Surface of Human Atherosclerotic Carotid Plaques
Authors: Dujovny Manuel , Kossovsky Nir , Loubeau Jean-Michel , Nelson Debra , McManus George
Published: May 2010

Forty specimens of carotid plaque from 30 patients who had suffered cerebrovascular accidents and 10 asymptomatic control patients were examined by light and scanning electron microscopy (SEM). The SEM revealed the finely detailed surface characteristics of the plaque including cell deposits, endothelial damage, and exposed subendothelium. X-ray energy spectrography scans revealed that 7 specimens had calcium deposits. Presurgical treatment with dipyridamole and aspirin inhibited or substantially reduced thrombus formation.
Spontaneous Cervical Carotid Artery Dissection
Authors: Chapleau Charles E. , Robertson James T.
Published: May 2010

The authors report a patient with spontaneous high cervical internal carotid artery dissection and a severe reversible ischemic deficit. Successful treatment consisted of 5 months of continuous intravenous heparin using an implantable infusion device. The details of this therapy are described, and alternative therapeutic modalities are discussed.
Tuberculous Brain Abscess
Authors: Leblanc Richard
Published: May 2010

A 27-year-old Vietnamese male immigrant to Canada developed a hemispheric cerebellar abscess. The patient presented at the hospital with osteomyelitis of the 5th finger of the left hand. He complained of lassitude, weight loss, and early morning headache, nausea, and vomiting, and he developed a left facial weakness. A computed tomographic scan demonstrated the distinctive appearance of an abscess of the left cerebellar hemisphere. Aspiration of the abscess afforded immediate relief of obstructive hydrocephalus and provided pus from which Mycobacterium tuberculosis was grown, thus permitting specific antituberculous chemotherapy. The cerebrospinal fluid obtained at the time of operation was sterile. The patient recovered fully. A primary site of infection was not conclusively identified.
Microsurgery of the Third Ventricle: Part 1
Authors: Yamamoto Isao , Rhoton Albert L. , Peace David A.
Published: May 2010

The 3rd ventricle is one of the most surgically inaccessible areas in the brain. It is impossible to reach its cavity without incising some neural structures. Twenty-five cadaveric brains were examined in detail to evaluate the surgically important relationships of the walls of the 3rd ventricle. The routes through which the 3rd ventricle can be reached are: (a) from above, through the foramen of Monro and the roof after entering the lateral ventricle through the corpus callosum or the cerebral cortex; (b) from anterior, through the lamina terminalis; (c) from below, through the floor if it has been stretched by tumor; and (d) from posterior, through the pineal region or from the posterior part of the lateral ventricle through the crus of the fornix. The posterior part of the circle of Willis and the basilar artery are intimately related to the floor, the anterior part of the circle of Willis and the anterior cerebral and anterior communicating arteries are related to the anterior wall, and the posterior cerebral artery supplies the posterior wall. The deep cerebral venous system is intimately related to the 3rd ventricle; the internal cerebral vein is related to the roof, and the basal vein is related to the floor. The junction of these veins with the great vein forms a formidable obstacle to the operative approach to the pineal gland and the posterior part of the 3rd ventricle.
Giant Arteriovenous Malformation of the Vein of Galen
Authors: Smith Donald R. , Donat Jane F.
Published: May 2010

An infant in whom a large aneurysm of the vein of Galen was treated by total surgical excision is presented. Other cases from the literature are discussed. The advantages of total extirpation over other treatment methods are emphasized.
Extracranial Metastases of Oligodendroglioma
Authors: Ordóñez Nelson G. , Ayala Alberto G. , Leavens Milam E.
Published: May 2010

The case of a 33-year-old woman with oligodendroglioma with extraneural metastases involving the masseter muscle, the cervical lymph nodes, the lumbar vertebrae, and the right iliac bone is described. Oligodendroglioma with metastases outside the central nervous system is extremely rare, and only a very few cases have been reported.
Compression of the Ulnar Nerve in Guyon's Canal by a Soft Tissue Giant Cell Tumor
Authors: Rengachary Setti S. , Arjunan Kadayampatti
Published: May 2010

A case of compression of the deep motor branch of the ulnar nerve in Guyon's canal by a giant cell tumor arising from the carpometacarpal joint is described. The pertinent anatomy and clinical features are reviewed.
Occurrence and Implications of Seizures in Subarachnoid Hemorrhage Due to Ruptured Intracranial Aneurysms
Authors: Hart Robert G. , Byer John A. , Slaughter James R. , Hewett John E. , Easton Donald J.
Published: May 2010

The records of 100 consecutive cases of subarachnoid hemorrhage due to ruptured aneurysm were reviewed to determine the incidence and the prognostic implications of seizures during the acute phase. Seizures occurred in 26% of the patients. Sixty-three per cent of the seizures occurred near the onset of the initial hemorrhage. The occurrence of these early seizures did not correlate with the location of the aneurysm or the prognosis. Most of the remaining seizures occurred immediately after rebleeding, with no greater morbidity or mortality compared to all patients who rebled. Pathogenic mechanisms of seizures associated with subarachnoid hemorrhage are proposed and discussed.
Biological Features of Meningiomas That Determine the Production of Cerebral Edema
Authors: Smith Harold P. , Challa Venkata R. , Moody Dixon M. , Kelly David L.
Published: May 2010

Although meningiomas are known to cause varying degrees of cerebral edema, the relative importance of their location, size, histological subtype, and other histological features in the production of cerebral edema has not been studied adequately. Therefore, we undertook a retrospective analysis of 43 meningiomas excised between 1975 and 1980. The results indicate that histological subtype has no relationship to the production of cerebral edema, with one exception. Meningiomas containing partly or completely a hemangiopericytic component were the only histological subtype associated consistently with cerebral edema. The location of a meningioma per se may not determine the production of cerebral edema. A relationship between size, aggressive histological features, vascular proliferative changes, and the production of cerebral edema was seen. The need for and the nature of further studies required to explain the cerebral edema that may be associated with small meningiomas are discussed.
Neurosurgical Admissions to the Intensive Care Unit
Authors: Knaus William A. , Draper Elizabeth , Lawrence Diane E. , Wagner Douglas P. , Zimmerman Jack E.
Published: May 2010

Among 624 consecutive admissions to a medical-surgical intensive care unit (ICU), we identified 289 patients admitted for concentrated nursing care and intensive monitoring of whom only 44 (15%) received active treatment before discharge. Within this group were 82 patients admitted after uncomplicated elective neurosurgery. Only 1 of these patients required active treatment before discharge. None had any major physiological abnormality detected by electronic monitoring, and no patient required readmission to the ICU or died during hospitalization. These 82 neurosurgical admissions accounted for 13% of the total admissions over the study period and 10.5% of the total number of ICU days. The admission of these patients to the ICU was prompted by the need for labor-intensive services, such as hourly neurological checks, that were not available on the regular hospital floor. For stable postoperative neurosurgical patients, improved staffing of hospital wards could lead to a reduction in the number of admissions to the ICU.