bluuebunny/crossref_metadata_2025 huggingface dataset:
Fusarium brain abscess
Authors: Steinberg Gary K. , Britt Richard H. , Enzmann Dieter R. , Finlay Jonathan L. , Arvin Ann M.
Published: May 2009

✓ The common soil fungus, Fusarium, is rarely pathogenic in man but occasionally causes serious disease, particularly in immunocompromised hosts. A case is reported of Fusarium brain abscess and meningitis occurring in a patient with chronic infectious mononucleosis syndrome and immunodeficiency. The patient died despite aspiration of the abscess and treatment with amphotericin B. This case demonstrates the importance of identifying the offending pathological organism through abscess aspiration in immunocompromised patients.
Trigeminal artery to cavernous sinus fistula treated by balloon occlusion
Authors: Kerber Charles W. , Manke William
Published: May 2009

✓ A spontaneous cavernous sinus fistula developed following presumed sinusitis, and was found to originate not from the carotid artery but from a persistent trigeminal artery. The fistula was treated by introducing a detachable latex balloon via a femoral artery approach through the trigeminal artery and then into the cavernous sinus. Flow through the carotid, vertebral, and trigeminal arteries was preserved.
Supraophthalmic carotid infusion for brain-tumor chemotherapy
Authors: Kapp John P. , Ross Robert L. , Tucker Elton M.
Published: May 2009

✓ The ocular complications of intracarotid infusion of drugs for brain-tumor chemotherapy may be eliminated by infusion of the chemotherapeutic agent into the carotid artery above the origin of the ophthalmic artery. The authors have developed a catheter that can negotiate the carotid siphon. This catheter is not balloon-tipped but incorporates a flexible tip with an expanded end to facilitate drag by flowing blood. The exit hole is placed to allow remote manipulation of the tip by hydraulic forces. Using this catheter, the authors have been consistently able to infuse the supraophthalmic carotid artery.
Operative management of selected brachial plexus lesions
Authors: Kline David G. , Judice Donald J.
Published: May 2009

✓ A 12-year operative experience with 171 consecutive patients with severe brachial plexus lesions who had at least 1½ years of follow-up review is analyzed. Selection for and timing of operation was helped by categorization of each individual plexus element as “completely” or “incompletely” injured and as “in continuity” or “not in continuity.” Results for each element could be given a single grade by a system which defined that element's proximal and distal input.

For most lesions in continuity, an operative delay of several months is advocated so that intraoperative electrical evaluation can be used. Thus, in 282 gunshot wounded and stretch-injured elements of which 210 were thought to be clinically complete, 63 were spared resection because of nerve action potentials (NAP's) found at intraoperative testing, and 57 recovered function with only neurolysis. Elements resected (120) were confirmed as neurotmetic both by intraoperative electrical and subsequent histological studies. Acceptable results were achieved in 16 of 24 sutures, in 43 of 89 grafts, and in each of seven split repairs. Upper trunk and lateral and posterior cord elements fared better than lower trunk and medial cord lesions unless the latter were shown, with evidence of NAP's, to be regenerating and could be spared resection. Some stretched elements could, however, not be repaired, even though an attempt was made to exclude such cases from operation.

Lacerations to the brachial plexus where continuity is lost are best repaired primarily if the injury is sharp; in this series, 14 of 18 elements having such repair recovered, whereas in 37 elements with secondary repair, grafts were often necessary and only 50% recovered function. Although associated with skin lacerations, 17 elements with complete loss were in continuity, and six of these were shown to be regenerating and were not resected. Despite intraneural location, large size, and prior operation, many benign tumors (including neurofibromas) can be removed without significant loss by use of the surgical loupes or microscope and repetitive NAP recording. Surgery for selected brachial plexus lesions is worthwhile.
Brain-tumor imaging using radiopaque perfluorocarbon
Authors: Patronas Nicholas J. , Hekmatpanah Javad , Doi Kunio
Published: May 2009

✓ Perfluorocarbon, a new tumor-seeking x-ray contrast agent, was injected into three rats with experimental brain tumors. After 1 to 3 days the rats were sacrificed, and the brains were removed and subjected to x-ray study. All showed dense radiopaque areas which correlated with the size and shape of the corresponding brain tumors. Conversely, none of the radiograms taken of the brain tumor in five rats receiving no perfluorocarbon (control animals) showed similar increased density. These findings suggest that perfluorocarbon may serve a useful role as a contrast medium for computerized tomography studies of brain tumors in man.
Arterial blood supply of the normal human pituitary gland
Authors: Leclercq Toussaint A. , Grisoli Francois
Published: May 2009

✓ A technique for the removal of sphenoid blocks from cadavers and for selective injection of the hypophyseal arteries of these specimens is described. Results of such injections are presented, with emphasis on the role of the inferior hypophyseal artery (IHA). The IHA was found to be the most important artery supplying the pituitary gland, and in particular, the structures involved in production, transportation, and storage of the antidiuretic hormone. The literature pertinent to the arterial blood supply of the normal pituitary gland is reviewed.
Creatine kinase isoenzymes in severe head injury
Authors: Hans Pol , Born Jacques Daniel , Chapelle Jean-Pierre , Milbouw Germain
Published: May 2009

✓ Brain-type creatine kinase (CK) isoenzyme (CK-BB) was found in the ventricular cerebrospinal fluid (CSF) and the serum in a series of 35 patients within 13 hours following severe head injury. There was a good correlation between total CK and CK-BB activities in CSF only. The values found in the CSF appear to be a quantitative index of brain dysfunction at admission, and did not correlate with intracranial pressure activity. High levels of CK-BB in the CSF correlated with a poor outcome, and thus offer a reliable criterion for the assessment of the severity of head injury.
Early versus delayed heparin reversal after carotid endarterectomy in the dog
Authors: Ercius Mark S. , Chandler William F. , Ford John W. , Burkel William E.
Published: May 2009

✓ The present study investigates the hematological reaction to arterial injury during the first 10 minutes after endarterectomy in dogs to determine if heparin reversal during this early period predisposes to thrombus formation. Known platelet physiology would predict that heparinization during this early period would be useful to allow a fibrin-free platelet monolayer to form.

After systemic heparinization (145 µ/kg) of the experimental animals, 42 endarterectomies were performed. Blood flow was then resumed for specific periods of time, and the vessels were prepared for scanning electron microscopy. Group 1 vessels (from the unheparinized control group) revealed mural thrombus formation after 10 minutes of blood flow. Group 2 vessels revealed the progressive formation of a fibrin-free platelet monolayer after 2, 5, or 10 minutes of blood flow resumption under systemic heparinization. Group 3 arteries, harvested at 10 minutes, underwent immediate (within 1 to 2 minutes after resumption of flow) heparin reversal with protamine sulfate, and demonstrated numerous patches of fibrin covering the platelet monolayer. Group 4 arteries, studied after 3 hours of blood flow, also underwent immediate heparin reversal. Two of these seven specimens had clumps of fibrin overlying the platelet monolayer. The Group 5 vessels had heparin reversal at 10 minutes, and demonstrated no fibrin overlying the platelet monolayer after 3 hours of blood flow.

This study demonstrates the formation of a fibrin-free platelet monolayer over the endarterectomized vessel wall within 10 minutes of resumption of flow under systemic heparinization. These findings suggest that heparin may safely be reversed following a carotid endarterectomy if one awaits the initial critical 10 minutes of blood flow.
A study of human head vibrations using time-averaged holography
Authors: Hoyer Heinz-E. , Dorheide Jurgen
Published: May 2009

✓ Intact human cadaver heads were subjected to vibrations. The resonant frequencies over a range of 500 to 3000 Hz were determined. Vibration patterns at three frequencies were presented by means of time-averaged holography. The displacements were quantified and the highest amplitudes were found in the temporal region. Antinode centers were found superimposed on the squamatic suture. This method of holographic interferometry allows sensitive deformation measurements to be taken on intact human heads or skulls.
Clinical signs and evoked response alterations associated with chronic experimental cord compression
Authors: Schramm Johannes , Shigeno Taku , Brock Mario
Published: May 2009

✓ Cortical and spinal evoked potentials were used to monitor the effect of experimental chronic cord compression in cats. An implantable compression screw made it possible to maintain the animals unrestrained. The mean compression period was 10 weeks (maximum 16.5 weeks). Compression was increased by stepwise tightening of the screw at intervals of 4 to 7 days under ketamine anesthesia. Evoked potentials were monitored before and after each compression step with repeated recordings, and were analyzed in terms of alterations in amplitude, latency, and waveform. Amplitude response curves were plotted where the amount of compression at each recording was expressed as a percentage of total compression. Changes in spinal evoked potentials occurred rather early (mean 36% of total compression), while obvious cortical evoked potential changes appeared rather late (mean 91% of total compression). Neurological alterations appeared later than alterations in spinal evoked response but prior to alterations in cortical evoked response. Thus, alterations in cortical somatosensory evoked potentials in the presence of chronic spinal compression indicate a severe degree of compression and do not seem to be of diagnostic value in the early detection of chronic spinal cord compression. It is suggested that the monitoring of spinal rather than cortical evoked responses would be more useful in locating and detecting chronic compression spinal cord damage.
Control of blood flow in the cat spinal cord
Authors: Scremin Oscar U. , Decima Emilio E.
Published: May 2009

✓ Spinal cord blood flow (SCBF) and the effect of end-tidal CO2 concentration (ETCO2) on SCBF (CO2 reactivity) were studied in the lumbar spinal cord of cats by means of the hydrogen-clearance technique. Hydrogen gas was administered by inhalation, and its level in spinal cord tissue was estimated amperometrically with small (75 µm) platinum electrodes. The average SCBF's at normocapnia (ETCO2 = 4%) of the ventral horn gray matter and of the white matter at several locations were 43.2 and 16.2 ml·100 gm−1·min−1, respectively. For gray and white matter, the values of CO2 reactivity, estimated by the coefficient of the regression of SCBF (ml·100 gm−1·min−1) on ETCO2 (ml·100 ml−1) were 11.6 and 2.1, respectively. No differences in SCBF or CO2 reactivity were observed between intact animals kept under N2O-O2 ventilation and decerebrated animals with no anesthesia.

After an acute spinal section, ventral horn SCBF and CO2 reactivity (measured eight segments below the cordotomy) were not altered, in spite of the profound neural depression present (that is, spinal shock). Orthodromic (dorsal root) stimulation of the ventral horn neurons induced an average increase in blood flow of 128% above control values. Antidromic (ventral root) motoneuron activation failed to produce any significant changes in ventral horn blood flow.
Combined PGI2, indomethacin, and heparin improves neurological recovery after spinal trauma in cats
Authors: Hallenbeck John M. , Jacobs Thomas P. , Faden Alan I.
Published: May 2009

✓ Anesthetized cats were subjected to standardized cervical spinal trauma produced by a modification of the Allen weight-dropping method. One hour after injury, animals were randomly allocated to one of three treatment groups, in which they received 1) saline, 2) naloxone, or 3) combined treatment, consisting of indomethacin, heparin, and prostacyclin (PGI2). Treatment was continued for 4 hours. Neurological function was evaluated weekly by a neurologist unaware of the treatment group, and was graded by means of a scale modified from that of Tarlov. Functional recovery in animals receiving combined drug therapy was significantly better than in saline-treated control animals, and was similar to that observed in naloxone-treated animals. The findings are discussed with respect to “blood-damaged tissue interaction” and may have implications both with regard to the pharmacological management of acute spinal injury and to the mechanism of action of opiate antagonists.
Morphogenic potential of autogenous costal cartilage transplanted into the interparietal suture area of the rat
Authors: Kylämarkula Seija , Odont L. , Rönning Olli , Odont D.
Published: May 2009

✓ A study was carried out to determine the separability of costochondral tissue and to investigate the preservation of its integrity as a transplant to a relatively immobile osseous site. On 10-day-old rats, two autogenous rib sections, complete with bone and cartilage, were transplanted across the interparietal suture with the cartilaginous ends either in the same direction or in opposite directions; untreated rats were used as controls. The animals, injected with Alizarin red S, were killed 25, 50, and 75 days after the operation, 10 at each time. At 25 days after the operation the calvarial width and neurocranial height were significantly greater, and the strip of new white bone appeared wider in the experimental animals as compared to the untreated control rats; later, the differences were less pronounced. The changes in the neurocranial morphology seemed more symmetrical following positioning of the cartilaginous ends of the graft in opposite directions than when they were in the same direction. In some transplants the endochondral ossification process appeared normal at the termination of the experimental period, but signs of degeneration were also observed. The findings were considered to indicate that costochondral transplants are endowed with an intrinsic tissue-separating capacity, and that they can preserve their integrity for an extended period under relatively nonfunctional conditions.
Complete fracture-dislocation of cervical spine without permanent neurological sequelae
Authors: Baker Roy P. , Grubb Robert L.
Published: May 2009

✓ A case of complete fracture-dislocation of the lower cervical spine in which there were no permanent neurological sequelae is presented. The absence of permanent neurological deficits with this type of injury is rare. The primary mechanism of injury in this patient was believed to be hyperextension with rupture of the ligamentous structures, allowing complete dislocation of the C-6 body while the posterior elements remained in good alignment due to multiple fractures which “decompressed” the spinal cord.
Acute hemorrhage into pituitary adenoma with SAH and anterior cerebral artery occlusion
Authors: Majchrzak Henryk , Wencel Tadeusz , Dragan Tadeusz , Bialas Joanna
Published: May 2009

✓ The authors present the case of a patient with a pituitary tumor, who manifested signs of subarachnoid hemorrhage (SHA) and loss of consciousness. After he had regained consciousness, massive left-sided paralysis was noted. Angiography and computerized tomography showed hemorrhage into the tumor, SAH, and ischemia of the right frontal lobe as a result of occlusion of the anterior cerebral artery. Removal of the tumor 3 weeks after the SAH did not lead to resumption of the anterior cerebral artery blood flow.
Intraoperative myelography
Authors: Siqueira Edir B. , Kranzler Leonard I. , Schaffer Leslie
Published: May 2009

✓ In this article, the technique of intraoperative myelography is described. Its indications are given, and results in two illustrative cases are reported.
Detachable calibrated-leak balloon for superselective angiography and embolization of dural arteriovenous malformations
Authors: Viñuela Fernando V. , Debrun Gerard M. , Fox Allan J. , Kan Shinichi
Published: May 2009

✓ The authors describe a system comprising a small latex balloon attached to a Teflon catheter. The balloon has a distal calibrated leak which is used for intravascular embolization with isobutyl-2-cyanoacrylate. The balloon is easily detached after embolization. The combination of manual control of the balloon-catheter system, plus the ability of the balloon to navigate intra-arterially with the blood flow, makes this system suitable for superselective angiography and embolization of lesions supplied by the external carotid artery (ECA). This system avoids intimal dissection and concomitant arterial vasospasm when trying to negotiate steep distal curves of the ECA branches. Experimental embolization of several branches of the ECA in the dog, and clinical examples of treatment of dural arteriovenous malformations in three patients are described.
Arterial injection-digital subtraction angiography
Authors: Kelly William , Brant-Zawadzki Michael , Pitts Lawrence H.
Published: May 2009

✓ The authors report on a series of 60 patients who underwent arterial injection-digital subtraction angiography (AI-DSA) for evaluation of suspected cerebrospinal disease. High-quality images were consistently obtained, facilitating accurate diagnosis of a wide variety of traumatic, inflammatory, and neoplastic conditions. As experience has accumulated, the AI-DSA technique has all but supplanted conventional film-screen serialography at this institution. Important advantages of AI-DSA include reduced procedural time and decreased contrast agent burden, which mean increased patient safety. Film costs can also be markedly reduced. Moreover, image quality (information content) is not significantly affected. The technique is especially useful in emergency situations, in cases where multiple arterial injections and serialograms are required, and in cases in which transcatheter embolization is carried out. We feel these considerations will insure broadened application of this diagnostic modality as the AI-DSA equipment becomes more widely available.
Regional blood flow in RT-9 brain tumors
Authors: Blasberg Ronald G. , Molnar Peter , Horowitz Marc , Kornblith Paul , Pleasants Roger , Fenstermacher Joseph
Published: May 2009

✓ Regional blood flow (BF) was measured in RT-9 experimental brain tumors using carbon-14 labeled iodoantipyrine, the Kety tissue-exchange equations, and quantitative autoradiographic techniques. Blood flow was variable within tumor tissue, and the range of BF increased with increasing tumor size; the overall range was 6 to 138 ml/100 gm/min and the maximum range within an individual tumor was 55 ml/100 gm/min. In all but one case, mean tumor BF was less than that in the same anatomic region of the contralateral hemisphere (CBA). The magnitude of BF within individual tumor foci generally could be related to tumor size, location (intraparenchymal versus extraparenchymal), and the presence of necrosis or cysts; it was lower in the geometric centers than in the periphery of medium-sized and large tumors. Brain adjacent to tumor had higher BF's than the tumor periphery; generally, the BF in the brain adjacent to the tumor was less than that in the CBA. A global depression of BF was observed within tumor-free cortex and corpus callosum of the hemisphere ipsilateral to tumor implantation and primary growth, suggesting a hemispheric reduction in metabolic and functional activity.
Selective posterior rhizotomy for treatment of spasticity
Authors: Laitinen Lauri V. , Nilsson Stefan , Fugl-Meyer Axel R.
Published: May 2009

✓ In 1976, Fasano, et al., described a new technique of posterior rhizotomy for treatment of spasticity. They stimulated electrically fascicles of the posterior roots in spastic patients and found that some fascicles responded to stimulation with tonic muscle contractions. They cut these fascicles, preserving those with a weaker or no reaction. The present authors have used a fairly similar technique in the treatment of eight patients with spasticity of the legs and one patient with spasticity of the arm: all fascicles of the posterior roots T12-S1 and C6–8, respectively, were stimulated electrically during surgery under general anesthesia. Approximately 60% to 80% of the fascicles responded to stimulation with tonic muscle jerks, and only these fascicles were cut. All nine patients showed a good reduction of spasticity. The residual cutaneous and joint sensation remained unchanged. Motility of the limbs usually improved.
Aminergic and cholinergic innervations of the spinal cord blood vessels of cats
Authors: Itakura Toru
Published: May 2009

✓ The distribution patterns of aminergic and cholinergic nerve fibers in the feline spinal cord blood vessels were studied by means of amine histofluorescence and acetylcholinesterase (AChE) staining. These patterns were compared with those of the cerebral blood vessels. The anterior spinal artery had a dense network of aminergic and AChE-positive (probably cholinergic) nerve fibers. The posterior spinal vein, in contrast, exhibited only aminergic nerve fibers. Small intraparenchymal blood vessels in the spinal cord also had strongly fluorescent (probably peripheral) aminergic nerve fibers, as well as pial spinal blood vessels. This was a characteristic feature in the spinal cord. The distribution pattern and the density of these two sorts of nerve fibers in the anterior spinal artery varied widely with the individual segment of the spinal cord. The thoracic spinal cord had the lowest number of these nerve fibers of any part of the spinal cord. This fact may explain why the thoracic spinal cord is most susceptible to ischemic change.
The favorable effect of early parenteral feeding on survival in head-injured patients
Authors: Rapp Robert P. , Pharm D. , Young Byron , Twyman Diana , Bivins Brack A. , Haack Dennis , Tibbs Phillip A. , Bean James R.
Published: May 2009

✓ This prospective randomized controlled clinical trial compares the effects of early parenteral nutrition and traditional delayed enteral nutrition upon the outcome of head-injured patients. Thirty-eight head-injured patients were randomly assigned to receive total parenteral nutrition (TPN) or standard enteral nutrition (SEN). Clinical and nutritional data were collected on all patients until death or for 18 days of hospitalization. Survival and functional recovery were monitored in survivors for 1 year. Of the 38 patients, 18 were randomized to the SEN group and 20 to the TPN group. Demographically, the two groups of patients were similar on admission. There was no significant difference in the severity of head injury between the two groups as measured by the Glasgow Coma Scale (p = 0.52). The outcome for the two groups was quite different, with eight of the 18 SEN patients dying within 18 days of injury, whereas no patient in the TPN group died within this period (p < 0.0001).

The basis for the improved survival in the TPN patients appears to be improved nutrition. The TPN patients had a more positive nitrogen balance (p < 0.06), and a higher serum albumin level and total lymphocyte count. More adequate nutritional status may have improved the patients' immunocompetence, resulting in decreased susceptibility to sepsis. The data from this study strongly support the favorable effect of early TPN on survival from head injury.
Sphenoethmoidal cephalocele with cleft palate: transpalatal versus transcranial repair
Authors: Lewin Michael L.
Published: May 2009

✓ Two cases of sphenoethmoidal encephalocele with cleft palate are reported in detail. The encephaloceles had prolapsed into the nose and nasopharynx, and protruded into the mouth. Previous examples of this entity are reviewed. Such patients have a typical facial appearance: hypertelorism, median cleft lip, and bifid nose of varied severity. Ocular findings include coloboma of the optic nerve or anophthalmia. The prolapsed cerebral tissue varies from nonfunctional glia elements to vital structures of the hypothalamus-pituitary area. Agenesis of the corpus callosum has been reported consistently.

Transcranial access to the bone defect, particularly its posterior portion, is difficult because of distorted cerebral anatomy and abnormal vasculature. The fragility of the prolapsed cerebral tissue makes it difficult to preserve the cerebral tissue intact and to reposition it into the cranium. When there is a cleft palate, it is possible to repair the encephalocele extracranially through a transoral, transpalatal approach, preserving and repositioning the content of the sac. Dural closure and obliteration of the bone defects are other essential steps of the operation. Both patients reported here were successfully operated on by the transoral, transpalatal route, at the age of 3 months and 4 years, respectively. They were followed for several years and had comprehensive endocrinological work-ups. One patient exhibited some pituitary deficiency requiring substitution therapy.
Endarterectomy for atheromatous hypoglossal artery
Authors: Osgood Carroll P. , Montanez Jaime A. , Karunaratne Esiri R. , Vandevander Dennis J.
Published: May 2009

✓ A 57-year-old white man developed transient ischemic symptoms of the posterior circulation in August, 1981. Serial arteriography revealed stenosis of a large right hypoglossal artery which narrowed from 50% to 90% after only 2 months. The hypoglossal artery occurs in the 4-mm human embryo, normally from Days 21 to 26 of gestation. This is the first reported case of hypoglossal endarterectomy.
Disappearance and development of cerebral aneurysms in moyamoya disease
Authors: Satoh Toru , Yamamoto Yuji , Asari Syoji , Sakurai Masaru , Suzuki Kenji
Published: May 2009

✓ The authors report a case of multiple cerebral aneurysms associated with moyamoya disease, in which the reduction and disappearance of bilateral internal carotid artery aneurysms and the new development and enlargement of basilar artery aneurysms were demonstrated on sequential cerebral angiograms. Possible mechanisms of the spontaneous disappearance and development of cerebral aneurysms in association with moyamoya disease are discussed.
Diastematomyelia and intramedullary epidermoid spinal cord tumor combined with extradural teratoma in an adult
Authors: Garza-Mercado Román
Published: May 2009

✓ Diastematomyelia is rarely diagnosed in the adult. Only a few such cases have been reported in the literature. A 26-year-old Mexican man with lumbar diastematomyelia is reported who also harbored a T-12 intramedullary epidermoid tumor and an extradural teratoma located in the dorsal aspect of the dural sac opposite L-4. These three rare coincidental lesions were removed at surgery. The patient's condition improved.
Multiple cerebral gummata
Authors: Punt Jonathan
Published: May 2009

✓ The case of a patient with multiple small cerebral gummata presenting with severely raised intracranial pressure is reported. The diagnosis, which was quite unexpected, was based on positive serological tests for syphilis. Computerized tomography (CT) showed small enhancing lesions with intense cerebral edema. The patient was treated successfully with penicillin, and resolution of the lesions was observed on CT scanning over a 1-year period. The importance of “routine” serological testing is noted.
Multiple meningiomas: a long-term review
Authors: Sheehy John P. , Crockard H. Alan
Published: May 2009

✓ Ten cases of multiple meningiomas seen over a 34-year period have been reviewed. The total case load from which these cases were selected was 566. The incidence of multiple meningiomas found prior to the introduction of computerized tomography (CT) in this series was 1.1%. The incidence since the introduction of CT was 8%. In eight cases all the tumors were found at the initial presentation and surgery; in the other two cases new tumors were discovered 1 and 4 years later. In only one case was von Recklinghausen's disease known to be present, and this patient developed new tumors. Six cases have been followed for 5 or more years, two for 16 years. Tumor recurrence has not been seen. All the patients were females. There was a higher proportion than usual of the whorling psammomatous type of tumor; papillary, angioblastic or malignant forms were not noted. The possibility of multiple meningiomas being a forme fruste of von Recklinghausen's disease is considered.
Cortical artery pressure in normotensive and hypertensive aneurysm patients
Authors: Fein Jack M. , Lipow Kenneth , Marmarou Anthony
Published: May 2009

✓ Cortical artery pressure (CAP) and systemic pressure (SP) were measured in eight normotensive and six hypertensive patients with anterior circulation aneurysms. In the hypertensive patients significant gradients developed between CAP and SP as these pressures were lowered. The relationship between CAP and SP was expressed by the best-fit equation CAP = 1.02 SP − 9.27 in the normotensive patients and by CAP = 1.54 SP − 65.60 in the hypertensive patients. In the latter, the cycle of decreasing and increasing pressures formed a hysteresis loop suggesting prolonged cortical vasoconstriction despite recovery of systemic pressure. Selective pressure measurements in the distal (D) and proximal (P) segments of the cortical arteries were also obtained. The D/P ratio describes the relative contribution of the collateral circulation to cortical artery pressure. In normotensive patients, the D/P ratio was maintained down to an SP of 48 mm Hg. In hypertensive patients this ratio decreased with lowered SP, and a critical closing pressure of 40 mm Hg was predicted for the distal circulation. These studies describe the limited capacity of the cortical circulation to maintain perfusion pressure in hypertensive patients. These responses should be considered when assessing the risks associated with such procedures as carotid ligation or hypotensive anesthesia.
Microsurgical anatomy of the veins of the posterior fossa
Authors: Matsushima Toshio , Rhoton Albert L. , Oliveira Evandro de , Peace David
Published: May 2009

✓ The microsurgical anatomy of the veins of the posterior fossa was defined in 25 cadavers. These veins are divided into four groups: superficial, deep, brain-stem, and bridging veins. The superficial veins are divided on the basis of which of the three cortical surfaces they drain: the tentorial surface, which faces the tentorium and is exposed in a supracerebellar approach, is drained by the superior hemispheric and vermian veins; the suboccipital surface, which is below and between the lateral and sigmoid sinuses and is exposed in a wide suboccipital craniectomy, is drained by the inferior hemispheric and inferior vermian veins; and the petrosal surface, which faces forward toward the posterior surface of the petrous bone and is retracted to expose the cerebellopontine angle, is drained by the anterior hemispheric veins. The deep veins course in the three fissures between the cerebellum and the brain stem, and on the three cerebellar peduncles. The major deep veins in the fissures between the cerebellum and brain stem are the veins of the cerebellomesencephalic, cerebellomedullary, and cerebellopontine fissures, and those on the cerebellar peduncles are the veins of the superior, middle, and inferior cerebellar peduncles. The veins of the brain stem are named on the basis of whether they drain the midbrain, pons, or medulla. The veins of the posterior fossa terminate as bridging veins, which collect into three groups: a galenic group which drains into the vein of Galen; a petrosal group which drains into the petrosal sinuses; and a tentorial group which drains into the tentorial sinuses near the torcula.
Sensory responses from stimulation of the inferior Rolandic and Sylvian regions in man
Authors: Van Buren John M.
Published: May 2009

✓ During the course of 134 craniotomies under local anesthesia, 274 sensory responses to electrical stimulation were recorded as to cortical site, type of sensation, and the site and lateralization of peripheral referral. The region of cortex exposed was largely the sensorimotor region near the Sylvian fissure and the temporal lobe. Differences in the type of sensation were seen on either side of the central fissure. Sensation of movement and specific sensations were reported more commonly from stimulation in the precentral region and crude sensation from the postcentral area. “Pain” was reported only once and taste not at all despite the large somatic sensory representation of the tongue. About 30% of the responses were referred to the ipsilateral side or bilaterally, with a somewhat higher percentage in the pre- than in the postcentral region. In general, the expected somatotopic sequence was followed, with tongue and mouth having the largest representation. An unexpected number of referrals to the head/face were found in the suprasylvian region, and it was uncertain whether this was part of Somatosensory area II. Eleven cases with sensory referrals to trunk/limbs in the suprasylvian area were found predominantly in the precentral region. No somatotopic pattern could be seen in these or on review of Penfield's material. Possible anatomical pathways for transmission of these responses were reviewed and questions raised as to the mechanisms involved.
Intraventricular cavernous hemangioma
Authors: Iwasa Hideaki , Indei Itsuo , Sato Fumiaki
Published: May 2009

✓ A case of intraventricular cavernous hemangioma in a neonate is reported. In over 200 previously reported cases of intracranial cavernous hemangioma, 11 histologically verified cases have been collected and analyzed. The present case is the second occurring in a neonate.
Moyamoya disease associated with persistent primitive trigeminal artery
Authors: Kwak Ryungchan , Kadoya Satoru
Published: May 2009

✓ Two cases of moyamoya disease associated with persistent primitive trigeminal artery (PTA) are reported. The first patient was a 44-year-old man who experienced a sudden severe headache brought about by an intracerebral hematoma in the left temporoparietal lobe. Four-vessel study showed a right-sided PTA and moyamoya disease. The second patient was a 56-year-old woman with similar symptoms and a hematoma in the right temporoparietal lobe. Four-vessel study showed a left-sided PTA and moyamoya disease. Among the 212 PTA cases reported in the literature, none has been associated with moyamoya disease. Moreover, there are no cases of moyamoya disease among the 119 cases of persistent primitive hypoglossal artery (PHA), which is thought to be a vascular anomaly fundamentally similar to PTA. None of the 907 cases of moyamoya disease reported in Japan has been associated with either PTA or PHA. Nonetheless, the embryonic stage when PTA or PHA normally disappears partially overlaps that period when moyamoya-like vascular anomalies have been thought to arise. The possible developmental relationship beween these two varieties of vascular abnormality is discussed.
Intrachiasmatic craniopharyngioma
Authors: Duff Thomas A. , Levine Ross
Published: May 2009

✓ A patient with bitemporal hemianopsia was found to have an enlarged optic chiasm. Biopsy of the intrachiasmatic tissue revealed craniopharyngioma.
Neurosurgery in the eighties: a challenge
Authors: Wrenn Frank R.
Published: May 2009

✓ The President of the American Association of Neurological Surgeons (AANS) discusses some matters of serious concern to neurosurgeons as they enter the last two decades of the 20th century. Some considerations derived from the long-range planning process of the Board of Directors of the AANS are described, along with goals and objectives which are designed to produce more consistent plans, actions, and information management. After a review of several published discussions of the dilemma of American physicians, there follows a challenge to neurosurgeons to look within themselves, to lay aside self-serving activities, and to rededicate themselves to the service of neurosurgical causes with the pursuit of excellence as their major goal.
Immunobiology of primary intracranial tumors
Authors: Mahaley M. Stephen , Bigner Darell D. , Dudka Lynn F. , Wilds Peggy Rae , Williams Darlene H. , Bouldin Thomas W. , Whitaker John N. , Bynum Jane M.
Published: May 2009

✓ Twenty patients with malignant gliomas were selected for active immunization within 4 weeks following surgery. Each patient had a Karnofsky Functional Rating equal to or greater than 70, a peripheral blood lymphocyte count equal to or greater than 1000 cells/cu mm, skin test responses to one or more of four recall antigens, peripheral blood T-cells equal to or greater than half that of control, and was not receiving steroid therapy at the time of entry into the study. Each patient received subcutaneous inoculations with one of two human glioma tissue culture cell lines (D-54MG or U-251MG) monthly, with 500 µg of bacillus Calmette-Guérin cell wall (BCG-CW) being included with the first inoculation. Each patient also received levamisole, 2.5 mg/kg 3 days per week every other week. Radiotherapy and chemotherapy with BCNU were begun after the first month of immunization. Follow-up evaluations included computerized tomography brain scans, neurological examinations, Karnofsky Functional Ratings, and studies of general immune competence. No evidence of allergic encephalomyelitis was noted clinically, nor was any gross or microscopic evidence of such pathology obtained upon autopsy of three of these patients. Serial studies of general immune competence showed no alterations from those previously described with non-immunized patients. Patients who were inoculated with the U-251MG cell line have had a longer survival time compared to those inoculated with the D-54MG cell line (p < 0.0590) or compared to 58 historical cases of glioma patients treated with levamisole, radiation therapy, and chemotherapy alone (p < 0.02).
Preliminary experience with Brown-Roberts-Wells (BRW) computerized tomography stereotaxic guidance system
Authors: Heilbrun M. Peter , Roberts Theodore S. , Apuzzo Michael L. J. , Wells Trent H. , Sabshin James K.
Published: May 2009

✓ The production model of the Brown-Roberts-Wells (BRW) computerized tomography (CT) stereotaxic guidance system is described. Hardware and software modifications to the original prototype now allow the system to be used independently of the CT scanner after an initial scan with the localizing components fixed to the skull. The system is simple and efficient, can be used universally with all CT scanners, and includes a phantom simulator system for target verification. Preliminary experience with 74 patients at two institutions is described. It is concluded that CT stereotaxic guidance systems will become important tools in the neurosurgical armamentarium, as they allow accurate approach to any target identifiable on the CT scan.
The role of hemoglobin in the etiology of cerebral vasospasm
Authors: Boullin David J. , Tagari Philip , du Boulay George , Aitken Victoria , Hughes J. Trevor
Published: May 2009

✓ Oxyhemoglobin was injected intracisternally into three baboons, and methemoglobin into one baboon, in an attempt to mimic the prolonged cerebral arterial spasm sometimes seen after subarachnoid hemorrhage due to aneurysm rupture. Cerebral angiography was performed for up to 7 days after injection of hemoglobin, and the degree of vasospasm was estimated from the angiograms. Oxyhemoglobin caused slight arterial narrowing, which lasted for 3 days. Methemoglobin had no significant effects. Motor neurological deficits and histopathological signs, characteristic of prolonged cerebral vasospasm, were not observed. It was concluded that hemoglobin alone is not capable of causing the cerebral vasospasm syndrome in these experimental animals.
Lactate and pyruvate metabolism in injured cat spinal cord before and after a single large intravenous dose of methylprednisolone
Authors: Braughler J. Mark , Hall Edward D.
Published: May 2009

✓ The lactate content and the lactate/pyruvate ratio of the acutely traumatized cat spinal cord have been studied and were found to rise rapidly following a 400 gm-cm injury. Lactate levels rose nearly twofold within 5 minutes after injury, peaked at 2 hours after injury, and remained significantly elevated for at least 8 hours compared to an adjacent uninjured segment of traumatized cord. Pyruvate levels, on the other hand, fell acutely in the injured section of cord during the 1st hour after injury then rose slowly over an 8-hour period. The changes in tissue lactate and pyruvate metabolism in the spinal cord following injury are consistent with a marked injury-induced reduction in blood flow. The elevation in lactate and the fall in pyruvate levels observed at 1 hour after injury were completely prevented by the intravenous administration of a single 30-mg/kg dose of methylprednisolone sodium succinate at 30 minutes after injury. Lower or higher doses of methylprednisolone were far less effective. The effects of the 30-mg/kg dose of methylprednisolone on tissue lactate content were associated with high tissue levels of the glucocorticoid and were short-lived, paralleling the accumulation and elimination pattern of steroid from the injured tissue. The results suggest that, in addition to other reported beneficial actions of large intravenous doses (30 mg/kg) of methylprednisolone on the injured cord, the glucocorticoid may also improve blood flow to the injured segment as has been suggested by others. The use of high glucocorticoid doses, early therapy initiation, and rigorous maintenance dosing is discussed.
The National Traumatic Coma Data Bank
Authors: Marshall Lawrence F. , Becker Donald P. , Bowers Sharon A. , Cayard Carol , Eisenberg Howard , Gross Cynthia R. , Grossman Robert G. , Jane John A. , Kunitz Selma C. , Rimel Rebecca , Tabaddor Kamran , Warren Joseph
Published: May 2009

✓ This paper describes the pilot phase of the National Traumatic Coma Data Bank, a cooperative effort of six clinical head-injury centers in the United States. Data were collected on 581 hospitalized patients with severe non-penetrating traumatic head injury. Severe head injury was defined on the basis of a Glasgow Coma Scale (GCS) score of 8 or less following nonsurgical resuscitation or deterioration to a GCS score of 8 or less within 48 hours after head injury.

A common data collection protocol, definitions, and data collection instruments were developed and put into use by all centers commencing in June, 1979. Extensive information was collected on pre-hospital, emergency room, intensive care, and recovery phases of patient care. Data were obtained on all patients from the time of injury until the end of the pilot study.

The pilot phase of the Data Bank provides data germane to questions of interest to neurosurgeons and to the lay public. Questions are as diverse as: what is the prognosis of severe brain injury; what is the impact of emergency care; and what is the role of rehabilitation in the recovery of the severely head-injured patient?
Effects of intraparenchymal hemorrhage on extracellular cortical potassium in experimental head trauma
Authors: Hubschmann Otakar R. , Kornhauser David
Published: May 2009

✓ A model of intraparenchymal hemorrhage was created in 11 cats. The development of the parenchymal hemorrhage was accompanied by a massive cellular depolarization and K+ release in anatomically intact areas in the vicinity of the hematoma. The K+ clearance was rapid and in most instances total. This initial K+ release was not ischemic in origin but was the result of mechanical and chemical factors of the extravasated blood on cellular membranes. In contrast, an increased water content of the white matter did not affect the cellular function or levels of K+ in the extracellular space of the cerebral cortex in the recording area. The experimental results suggest that K+ release takes place at the onset of trauma in subcritically injured cellular areas in the vicinity of a hemorrhage. The cellular elements undergo massive depolarization which is accompanied by a number of chemical and biochemical changes that lead to cellular swelling. Cellular depolarization and K+ release appear to be the initial response of the central nervous system to trauma. The extent of this response may strongly influence the final degree of cellular damage and, thus, the neurological deficit in patients with head trauma.
Changes of the blood-brain barrier in experimental metastatic brain tumors
Authors: Hasegawa Hiroshi , Ushio Yukitaka , Hayakawa Toru , Yamada Kazuo , Mogami Heitaro
Published: May 2009

✓ An experimental model for blood-borne cerebral metastases was developed by introducing Walker 256 carcinoma cells selectively into the intracranial internal carotid artery of rats. This model was used to study the regional capillary permeability of rat brain and metastatic brain tumors of various sizes with the aid of 14C alpha-aminoisobutyric acid (AIB) quantitative autoradiography. The regional capillary permeability varied with the anatomical location and size of the tumor. Intraparenchymal tumors less than 1 mm in diameter showed no increased permeability to AIB. As the tumors enlarged over 1 mm in diameter, the permeability in the intraparenchymal tumors increased proportionally, but remained less than one-third of capillary permeability of subcutaneously transplanted tumors. Capillary permeability in the peripheral invasive part and necrotic center was less than in the viable part of large tumors. Capillary permeability in metastatic tumors of the choroid plexus and meninges was significantly higher than in tumors of the brain parenchyma. The results suggest that the uptake of chemotherapeutic agents that do not cross the blood-brain barrier easily varies with the anatomical location and size of the metastatic tumors.
Cerebellar neoplasm of mixed mesenchymal and neuroepithelial origin
Authors: Shuangshoti Samruay , O'Charoen Supat
Published: May 2009

✓ A 3½-year-old boy had a neoplasm of mixed mesenchymal and neuroepithelial origin in the cerebellar vermis. The tumor was composed of rhabdomyosarcoma and medulloblastoma. There was additional differentiation within the neuroepithelium, including neoplastic neurons, neuroblasts, astroglia, oligodendroglia, ependymal cells as well as foci of glioblastomatous transformation. It is suggested that this combined tumor arose from the neural crest or combined neural crest and neural tube. The rhabdomyosarcoma could have arisen from the mesenchymal portion of the neural crest, and the medulloblastoma from the neuroectodermal part of the neural crest or from the neural tube itself. The two tumor types formed a neoplasm of mixed mesenchymal and neuroepithelial origin.
Possible significance of juvenile oral venous angioma as marker of intracerebral vascular lesion
Authors: Majchrzak Henryk , Wencel Tadeusz , Bierzyńska-Macyszyn Grazyna , Bielska Janina
Published: May 2009

✓ This 10-year-old child suffered a hemorrhage into the right parietal lobe, the result of a ruptured arteriovenous angioma. From birth, the boy had a venous angioma of the mucous membrane of the cheek, lower lip, and hypoglossal area on the right side. The coexistence of these two vascular defects is most unusual, and venous angioma in early life may suggest the presence of cerebral angioma.
Concurrent delayed temporal and posterior fossa epidural hematomas
Authors: Cervantes Luis A.
Published: May 2009

✓ A case of delayed epidural hematoma presenting in two different intracranial compartments is described. The presumptive mechanism of the lesion is discussed and the value of early reevaluation by computerized tomography is stressed.
Recent research into the nature of cerebrospinal fluid formation and absorption
Authors: McComb J. Gordon
Published: May 2009

✓ Recent information regarding the nature of bulk cerebrospinal fluid formation and absorption is reviewed, integrated with previous knowledge, and applied to the clinical setting.