bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Recurrent Brain Stem Gliomas and Other Central Nervous System Tumors with 5-Fluorouracil, CCNU, Hydroxyurea, and 6-Mercaptopurine
Authors: Rodriguez Luis A. , Prados Michael , Fulton Dorcas , Edwards Michael S. B. , Silver Pamela , Levin Victor
Published: May 2010

Twenty-one patients with recurrent malignant central nervous system gliomas were treated with a combination of 5-fluorouracil, CCNU, hydroxyurea, and 6-mercaptopurine. Thirteen patients had brain stem gliomas, 3 patients had spinal cord gliomas, 3 patients had thalamic gliomas, and 2 patients had cerebellar astrocytomas. All patients had received radiation therapy, and 4 brain stem patients had also been treated with chemotherapy. Sixteen patients (76%) responded to treatment with either stabilization of disease or improvement. Nine of the 13 patients with brain stem gliomas (71%) had response or stabilization of disease. The median time to tumor progression (TTP) for the brain stem patients who responded or had stabilization of disease was 25 weeks. The median survival from recurrence for the brain stem glioma patients was 27 weeks. Patients with cerebellar, thalamic, and spinal cord tumors did very well, with an 87% response or stabilization of disease and a median TTP of 122 weeks.
Intradural Herniated Dorsal Disc: Case Report and Review of the Literature
Authors: Isla Alberto , Roda José M. , Bencosme José , Alvarez Marcelino P. , Blázquez Martín G.
Published: May 2010

A 67-year-old man with a 1 1/2;-month history of spastic paraparesis caused by a dorsal intradural disc herniation underwent surgical treatment via a posterior approach. Dorsal herniated discs are rare, and intradural dorsal disc herniations are even more infrequent. Including this case, the medical literature reviewed describes only four such cases.
Origin of Organisms Infecting Ventricular Shunts
Authors: Shapiro Scott , Boaz Joel , Kleiman Martin , Kalsbeck John , Mealey John
Published: May 2010

Results of skin cultures obtained before 413 of 505 operations for cerebrospinal fluid-diverting ventricular shunt placement or revision in a pediatric population from April 1980 to May 1983 are analyzed and compared to results of cultures from 20 subsequent shunt infections. Sensitivities to 11 different antibiotics were determined for each isolate cultured. The total operative infection rate was 20 of 505 (4%). Gram-negative bacilli alone accounted for 3 of 20 (15%) shunt infections. One gram-negative bacillus/Staphylococcus aureus infection occurred. Factors predisposing for gramnegative bacillus shunt infection were found in all 4 cases. The majority of shunt infections were caused by typical resident skin organisms: Staphylococcus epidermidis alone, 9/20 (45%); Staphylococcus aureus alone, 4/20 (20%); Corynebacterium sp., 1/20 (5%); α-Streptococcus with S. epidermidis, 1/20 (5%); and Micrococcus with S. epidermidis, 1/20 (5%). Only 4 (20%) of the 20 shunt infections were due to organisms identical to those originally grown from the skin. Another 4 (20%) seemed to be infected with a strain of organism different from that initially recovered from the skin. The remaining skin organism shunt infections may or may not have come from the patient's skin. The data suggest that not all skin organism shunt infections arise from contamination by resident skin bacteria at the incision sites at the time of operation. Alternate sources for the infecting organisms are discussed. The antibiotic sensitivity data on skin isolates and shunt isolates suggest that vancomycin is the antibiotic best suited for prophylaxis against shunt infection at our institution.
Adipose Tissue in the Filum Terminale: A Computed Tomographic Finding That May Indicate Tethering of the Spinal Cord
Authors: McLendon Roger E. , Oakes Jerry W. , Heinz Ralph E. , Yeates Andrew E. , Burger Peter C.
Published: May 2010

Adipose tissue in the filum terminale is frequently associated with tethering of the spinal cord in patients with spina bifida occulta (3, 8). We recently saw a patient with low back pain and no spina bifida occulta, in whom adipose tissue was noted in the area of the filum on an unenhanced computed tomographic (CT) scan. The patient had a tethered cord. This case suggested that, when CT scanning is done as the first imaging study in the evaluation of low back pain, fatty tissue in the area of the filum may be an indicator for tethering of the spinal cord. The present study was undertaken to determine the validity of using CT scan-detectable filal fat in the identification of possible tethered spinal cords among a group of patients experiencing low back pain. The presence of fat in the fila of 12 patients with the radiologically and histologically tethered cord syndrome was evaluated and the fila of 47 autopsied patients whose clinical history showed no back pain were examined histologically. There were accumulations of adipose tissue in the fila of 11 of the 12 (91%) patients with the tethered cord syndrome and in the fila of 9 of the 47 patients (17%) in the autopsy series. Of the 9 autopsy patients with fat in their fila, however only 3 patients (6%) exhibited collections of adipose tissue in the CT detection range (2 mm). These results demonstrate that, although CT scan-detectable adipose tissue can be found in the filum of an occasional patient without tethered cord, CT detectable fat in the filum of a patient with low back pain should prompt an evaluation for a tethered spinal cord. CT scanning has potential as a noninvasive tool in such a work-up.
Bilateral Chronic Subdural Hematomas without Communication between the Hematoma Cavities: Treatment with Unilateral Subdural-Peritoneal Shunt
Authors: Aoki Nobuhiko , Masuzawa Hideaki
Published: May 2010

Communication between bilateral subdural hematoma cavities was not demonstrated by metrizamide computed tomography subdurography in three patients with bilateral chronic subdural hematomas. Because unilateral subdural tapping yielded a slack fontanel without untoward neurological findings, patients were treated by the placement of unilateral subdural-peritoneal shunts, resulting in resolution of the bilateral hematomas.
Cerebral Malignant Tumors with Ependymal and Choroidal Differentiation in Two Siblings
Authors: Munoz David G. , Griebel Robert , Rozdilsky Bohdan , George David
Published: May 2010

Two siblings in a family without a history of phacomatosis or cerebral tumors developed malignant tumors in the posterior fossa at age 28 months and in the left cerebral hemisphere at age 15 months, respectively. Dual ependymal and choroid plexus epithelium differentiation was established by histological, ultrastructural, and immunocytochemical studies. The development of this rare tumor in siblings suggests an inherited predisposition, a common environmental insult, or both.
Myelopathy after the Intrathecal Administration of Hypertonic Saline
Authors: Kim R. C. , Porter R. W. , Choi B. H. , Kim S. W.
Published: May 2010

The neuropathological effects of intrathecally administered hypertonic saline have not been described previously. We report a patient who, within a day of receiving 20 ml of hypertonic (7.5%) saline intrathecally, developed flaccid paraplegia and complete sensory loss below the umbilicus. Subsequently, there was some transitory return of motor and coarse sensory function. The patient died 16 months after the injection. At autopsy, there was peripherally accentuated loss of myelinated fibers within the spinal cord from T12 downward, as well as dense collagenous thickening of the dorsal leptomeninges from T9 to T11. The findings in this case, coupled with observations made by others, serve to emphasize the need for extreme caution whenever planning any form of intrathecal therapy.
Anomalies and Variations of the Middle Cerebral Artery : A Micro anatomical Study
Authors: Umansky Felix , Dujovny Manuel , Ausman James I. , Diaz Fernando G. , Mirchandani Haresh G.
Published: May 2010

The microvascular anatomy of the main trunk and divisions of the middle cerebral artery was studied in 104 unfixed brain hemispheres injected with polyester resin and dissected under the operating microscope. The following anomalies and variations of the middle cerebral artery were found: fenestration (1 case; 1%), located on the first 4 mm of the main trunk of the middle cerebral artery; duplication (1 case; 1%). with vessels arising from the internal carotid artery; accessory middle cerebral artery (2 cases; 2%). originating on the A, segment of the anterior cerebral artery; single-trunk type of middle cerebral artery (4 cases; 4%), with no division of its main trunk; quadrifurcation (4 cases; 4%), in which the main trunk of the middle cerebral artery divided into four secondary trunks. The clinical implications of these anatomical findings are discussed, and photographs of representative specimens illustrate the anomalies.
Significant Functional Recovery after Delayed Evacuation of Traumatic Thoracic Intramedullary Hematoma: Case Report
Authors: Andrews Russell J. , Chien C.-C.
Published: May 2010

A patient with traumatic thoracic intramedullary hematoma underwent operation 1 month postinjury. Evacuation and syringosubarachnoid shunting resulted in return of bladder control and of sufficient strength in the lower extremities to permit independent walking. The outcome is discussed in light of the literature on traumatic intramedullary hematoma. The value of magnetic resonance imaging is noted. We suggest an aggressive diagnostic and therapeutic approach toward intramedullary spinal cord hematomas.
Teflon Injection for Vocal Cord Paralys is after Intracranial Operation
Authors: Heller Elliot M. , Ransohoff Joseph , Plasse Harvey , Cohen Noel L.
Published: May 2010

Vocal cord paralysis may follow intracranial operation if the vagus nerve is damaged intraoperatively. If the resulting laryngeal incompetence is severe, hoarseness, dysphagia, and aspiration may develop. This is often followed by a pneumonitis requiring chronic gastric tube feeding. Teflon vocal cord injection has been shown to restore the sphincteric action of the larynx and enable patients to phonate and swallow properly again. Nine patients underwent this procedure for chronic aspiration and hoarseness. All had vagus injury attributable to antecedent intracranial operation, and all experienced relief of their symptoms with only minor complications. Teflon vocal cord injection is advocated as a safe, effective means of managing patients with aspiration and dysphagia secondary to vagus nerve injury.
Differences in Glycoconjugates of Adrenocorticotropic Hormone-secretory Granules between Nonadenomatous Pituitary Cells and Adenoma Cells as Detected by Double Labeling
Authors: Hori Tomokatsu , Nishiyama Fumiaki , Anno Yuichi , Tanaka Satoshi , Watanabe Takashi , Hirano Hiroshi
Published: May 2010

Lectin binding sites of adrenocorticotropic hormone (ACTH) secretory granules of human pituitary adenomas and of nonadenomatous pituitary tissue adjacent to adenomas were studied by postembedding immunocytochemical doublestaining on ultrathin sections followed by electron microscopy. The specific hormones produced by the secretory granules were identified by labeling one side of the section with anti-human pituitary hormone antibodies conjugated to gold particles. Simultaneously, the other side was labeled with horseradish peroxidase-lectin to reveal lectin binding sites. Specimens were obtained from four human ACTH-producing pituitary adenomas and from nonadenomatous pituitary tissue surrounding three other adenomas. The four ACTH-producing adenomas showed either weak or negative reactions with concanavalin A, whereas the nonadenomatous ACTH-producing pituitary cells reacted strongly with concanavalin A. Moreover, ACTH secretory granules were significantly larger in the nonadenomatous cells than in adenoma cells. Differences in biochemical structure and ultrastructure between nonadenomatous (normal) pituitary cells and adenoma cells secreting the same specific hormones were demonstrated, and the clinical implications of the results were discussed.
Posterior Fossa Subdural Effusion Due to Head Trauma
Authors: Nishizaki Tomoyuki , Tamaki Norihiko , Fujiwara Hitoshi , Matsumoto Satoshi
Published: May 2010

We report 3 cases of posterior fossa subdural effusion resulting from head trauma, and we review 20 previously reported cases. All patients with the acute type presented with progressive deterioration of consciousness associated with stiff neck, seizure, and dyspnea (apnea). By contrast, in the subacute or chronic type, persistent headache, multiple cranial nerve pareses, and ataxia were characteristic. Occipital bone fracture was common in the acute type, and supratentorial subdural effusion was more frequently associated with the subacute or chronic type. Evacuation of the subdural fluid collection through a burr hole is the most common and effective treatment, but subdural-peritoneal shunting or closed drainage of the subdural fluid collection may be necessary. The prognosis of posterior fossa subdural effusion after head trauma is relatively good.
Pyriformis Syndrome in a 10-Year-old Boy as a Complication of Operation with the Patient in the Sitting Position
Authors: Brown Jeffrey A. , Braun Michael A. , Namey Thomas C.
Published: May 2010

We present a case of sciatic neuropathy due to the pyriformis syndrome after operation in the sitting position. Neither sciatic nerve injury nor the pyriformis syndrome has been reported after operation in the sitting position, although a low incidence of common peroneal nerve injury has been reported as a complication of operation on patients who are in the sitting position. The clinical findings of sciatic neuropathy, external rotation of the ipsilateral foot in the position of comfort, and a therapeutic response to local anesthetic injection into the pyriformis muscle are diagnostic of the syndrome. Nerve conduction studies should be performed to aid in the differentiation between a common peroneal and sciatic neuropathy. The syndrome may occur because of extreme flexion of the hips and prolonged pressure while in the sitting position, leading to pyriformis muscle trauma, resultant spasm, and sciatic compression. The prognosis is for complete recovery after symptomatic treatment with nonsteroidal antiinflammatory medication and physical therapy.
Functional Recovery after Decompressive Craniectomy for Cerebral Infarction
Authors: Kondziolka Douglas , Fazl Mahmood
Published: May 2010

There is continuing controversy about the benefits of decompressive craniectomy in the treatment of lesions causing increased intracranial pressure (ICP) and brain edema. Laboratory work has shown a decrease in ICP after craniectomy, but also a paradoxical enhancement in the formation of underlying cerebral edema, which may act to the detriment of the patient. Since Rengachary et al. advocated craniectomy for massive cerebral infarction and reported their group of three patients, we have managed five patients with acute supratentorial cerebral infarction who progressed to uncal herniation and impending death from raised ICP and brain stem compression. All were treated with frontotemporal craniectomy after conventional medical therapy failed to achieve a response. All patients survived and are walking, despite a paresis appropriate to their original stroke. Two have returned to work. Good results with supratentorial craniectomy after infarction show that this procedure is life-saving and can also give acceptable functional recovery.
Surgical Approaches to Aneurysms of the Vertebral and Basilar Arteries
Authors: Solomon Robert A. , Stein Bennett M.
Published: May 2010

This report details the surgical treatment of 44 patients with aneurysms of the vertebral and basilar arteries. Three different surgical approaches were utilized depending on the location of the aneurysm. These were an anterior supratentorial approach, a lateral suboccipital approach, and a combined supratentorial and infratentorial approach along the petrous apex, with section of the lateral sinus and the tentorium. Using these operative exposures, aneurysms located anywhere on the vertebral-basilar arteries may be safely visualized and clipped. In this series, 1 patient died, 4 other patients had significant, long-lasting morbidity as a result of operation, and 32 patients returned to work and a normal life-style. These data support operative intervention under proper conditions and with selection of the correct exposures for the treatment of vertebral-basilar aneurysms.
Ruptured Dissecting Aneurysm of the Vertebral Artery Revealed by Repeat Angiography
Authors: Ito Yasushi , Ishii Ryoji , Suzuki Yasuo , Kikuoka Masahisa , Hirano Kazuhiro , Kodama Shuhei
Published: May 2010

A case of subarachnoid hemorrhage caused by the rupture of a dissecting aneurysm of the vertebral artery is reported. The initial angiogram was normal, and repeat angiography carried out 12 days later revealed a dissecting aneurysm of the right vertebral artery. This angiographic change seems to be due to the progression of minimal dissection that was not found at the time of first angiogram.
Morbidity and Mortality of Carotid Endarterectomy under Local Anesthesia: A Retrospective Study
Authors: Zuccarello Mario , Yeh Hwa-shain , Tew John M.
Published: May 2010

It has been shown that carotid endarterectomy reduces the incidence of stroke in patients with symptomatic extracranial occlusive vascular disease in the absence of major perioperative complications such as stroke or death. We present a retrospective study of 106 carotid endarterectomies performed under local anesthesia in 100 patients in whom transient ischemic attack (TIA) or minor stroke had occurred. Nonfatal stroke occurred in 2%, and TIA occurred in 1%. There was no perioperative mortality. Our study suggests that, under local anesthesia, even high risk patients can be operated safely and the majority of carotid endarterectomies can be performed without the use of an indwelling shunt. Meticulous surgical technique is of great importance for achieving low perioperative complications.
Optic Nerve Decompression for Osteopetrosis in Early Childhood
Authors: Haines Stephen J. , Erickson Donald L. , Wirtschafter Jonathan D.
Published: May 2010

Visual failure in osteopetrosis may result from retinal degeneration or compression of the optic nerve in the narrowed optic canals. We report the evaluation and treatment of five children with osteopetrosis whose optic nerve dysfunction seems to have been related to the latter etiology. Evaluation of visual function was carried out by means of behavioral observation and flash visual evoked responses. Of six nerves evaluated both pre- and postoperatively, the visual evoked responses seemed to improve in four. Three nerves were serially evaluated without an operation, and one showed changes consistent with maturation. One nerve was evaluated with serial postoperative evoked potentials and showed no change. We conclude that surgical decompression of the optic nerve in patients with documented optic nerve dysfunction and osteopetrosis allows improvement in visual function and is, therefore, an important consideration in the evaluation and management of patients with this disease.
Intraoperative Development of Contralateral Epidural Hematoma during Evacuation of Traumatic Extraaxial Hematoma
Authors: Feuerman Tony , Wackym Phillip Ashley , Gade George F. , Lanman Todd , Becker Donald
Published: May 2010

Intraoperative development of an epidural hematoma contralateral to a craniotomy for acute traumatic extraaxial hematoma has been previously reported. This entity, however, has never been distinctly defined and differentiated from either the delayed or the bilateral acute epidural hematoma. We present 3 new cases of intraoperative contralateral acute epidural hematoma and review the 14 previously reported cases. The typical clinical presentation is a severe head injury with an acute extraaxial hematoma and severe ipsilateral brain displacement during craniotomy. If brain displacement is not noted at craniotomy, then the contralateral hematoma is manifested by immediate postoperative neurological deterioration or intractable elevated intracranial pressure. The presence of any of these signs makes an immediate postoperative CT scan or burr holes contralateral to the original craniotomy mandatory for early diagnosis. In addition to defining “intraoperative contralateral epidural hematoma,” stricter definitions of the terms “delayed epidural hematoma” (no hematoma present on the initial CT scan but one present on a later scan) and “bilateral epidural hematomas” (present on the initial scan) are proposed.
Three-Dimensional Computed Tomographic Reconstructions of Intracranial Meningiomas
Authors: Chalif David J. , Dufresne Craig R. , Ransohoff Joseph , McCarthy Joseph A.
Published: May 2010

In a series of four patients with intracranial meningiomas, three-dimensional computed tomographic (CT) reconstructions were a useful diagnostic and surgical adjunct. Three-dimensional images are created from standard CT data by a boundary-detecting computer software program. Three-dimensional images of tumor invading or adjacent to the bony calvarium are projected about the x, y, and z axes. Axial and sagittal sections delineate the lesions. The images created allow a surgical view of the meningiomas in three-dimensional space and demonstrate the relationship of these masses to the skull. The use of three-dimensional reconstructions in craniofacial surgery and in neurosurgery is reviewed.
Haemophilus paraphrophilus Frontal Lobe Abscess: Case Report
Authors: Pajeau Aurora K. , Yu Pauline K. W. , Ebersold Michael J. , Anhalt John P.
Published: May 2010

We report a case of cerebral abscess due to Haemophilus paraphrophilus in a 51-year-old man who was otherwise healthy and had no cardiac abnormality. A source for the infection was not definitively identified; however, the patient had had dental manipulations 2 weeks before the onset of symptoms, and an oral source is probable. The patient was treated successfully with antibiotics after removal of the abscess. Bacteriological studies are discussed.
Tension Pneumocephalus after Clipping of a Carotid-Ophthalmic Artery Aneurysm via an Interhemispheric Approach: Case Report
Authors: Asai Akio , Yamada Hisashi , Tsutsumi Kazuo , Takakura Kintomo
Published: May 2010

A case of postoperative tension pneumocephalus of unusual cause after carotid-ophthalmic artery aneurysm clipping is presented. A second craniotomy for decompression and exploration demonstrated a small fistula in the planum sphenoidale, which presumably had been made when the right optic canal was unroofed during the first operation.
Spinal Epidural Compression Secondary to Osteoblastic Metastatic Vertebral Expansion
Authors: Hirschfeld Alan , Beutler William , Seigle Juliet , Manz Herbert
Published: May 2010

We present two cases in which spinal epidural compression was caused by the expansion of bony elements into the spinal canal as a result of osteoblastic metastases. The precise nature of the compression was appreciated only on computed tomography. One patient had immediate and sustained neurological improvement after laminectomy. The other benefited temporarily, but widespread involvement of his spine ultimately led to paraplegia despite two more decompressive procedures. We think that bony expansion of the spine secondary to osteoblastic metastasis is not reversible with radiation therapy alone and is, therefore, an absolute indication for surgical decompression.
Spinal Cord Compression by a Unifocal Eosinophilic Granuloma: A Case Report of an Adult with Unusual Roentgenological Features
Authors: Kanterewicz Eduardo , Condom Enric , Cañete Juan D. , Del Olmo Josá A.
Published: May 2010

We describe an unusual case of unifocal eosinophilic granuloma of the spine in a 38-year-old woman who presented with spinal cord compression. After 2 years of back pain, x-ray films of the spine were normal, but computed tomography and magnetic resonance imaging demonstrated a lytic lesion of the 1st lumbar vertebral body with cephalic extension in the epidural space. The lesion was later confirmed at operation to be an eosinophilic granuloma spreading into the surrounding tissues.
Ulnar Neuropathy Caused by Fat Necrosis with Cystic Myxoid Degeneration at the Upper Forearm: Case Report
Authors: Segal Ricardo , Saito Reisuke , Sen Chandra
Published: May 2010

The case described is thought to be the first report of ulnar neuropathy caused by a cystic myxomatous degeneration of fat necrosis. The 12-day preoperative duration of symptoms is also the shortest reported for nontraumatic ulnar neuropathy; the average period between onset of symptoms and operation is 10 months. At operation, the patient's nerve was found to be stretched severely over the tumor, which was excised, thus decompressing the ulnar nerve. The procedure relieved the patient's symptoms of tingling and numbness, and he remained asymptomatic at the 12-month follow-up examination.
Endaneurysmal Microendarterectomy in the Treatment of Giant Cerebral Aneurysms: Technical Note
Authors: Hylton Phillip D. , Reichman O. Howard
Published: May 2010

Giant cerebral aneurysms continue to present the surgeon with substantial technical challenges. Operative techniques for managing giant cerebral aneurysms are becoming increasingly sophisticated. We emphasize in this report a technique for direct obliteration of the giant aneurysm with a hard, calcified atheroma at its base that prevents direct clip application without compromise of the parent artery. Temporary trapping of the aneurysm, intramural thrombectomy, and endaneurysmal microendarterectomy allow direct obliteration of the aneurysm neck with preservation of the parent artery.
Early Aneurysm Surgery and Prophylactic Hypervolemic Hypertensive Therapy for the Treatment of Aneurysmal Subarachnoid Hemorrhage
Authors: Solomon Robert A. , Fink Matthew E. , Lennihan Laura
Published: May 2010

The prevailing sentiment of North American neurosurgeons is that there is no significant difference in overall morbidity between patients who are treated with early aneurysm surgery and those who are treated with delayed aneurysm surgery. This concept is based primarily on the high incidence of ischemic events after early intervention. Recent experience, however, indicates that prophylactic hypervolemic hypertensive therapy may be beneficial in reducing delayed ischemia after early aneurysm surgery. During the preceding 21 months, we have performed 125 operations for intracranial aneurysms. Fifty-six patients in this group presented less than 7 days after subarachnoid hemorrhage (SAH) (47 within 3 days) and were treated by a prospective protocol of urgent aneurysm surgery performed within 24 hours after presentation. In all cases, the aneurysm was clipped with the use of mannitol and spinal drainage for brain relaxation. All patients were then treated with prophylactic volume expansion therapy and induced hypertension with a central venous pressure or a Swan-Ganz catheter until the 14th day after SAH. Preoperatively, 17 patients were Hunt and Hess Grade I, 9 were Grade II, 28 were Grade III, and 2 were Grade IV. In this group of 56 patients at risk for delayed ischemia from vasospasm, 5 patients had significant intraoperative complications. Ten patients (18%) had delayed cerebral ischemia, totally reversible in 6 cases, with small infarcts in 3 cases, and with 1 death (2% mortality from delayed ischemia), there were 5 cases of shunted hydrocephalus, and 3 deaths from other complications. Overall, 41 patients (73%) returned to their premorbid occupations without neurological deficit. Four patients (7%) are independent with no neurological deficits, but have not returned to full-time employment. Four patients (7%) are independent, but have permanent deficits. Three patients (5%) are dependent on others for care, and 4 patients (7%) died. These data imply that delayed cerebral ischemia after SAH can be effectively minimized with prophylactic volume expansion therapy. Similar results have been reported for patients treated with calcium channel blocking agents. Given these techniques, perhaps the assumption that early operative intervention holds no advantage over delayed surgical treatment of an aneurysm rupture should be readdressed in a scientifically controlled fashion.
Relationship between Flow Cytometric Features and Clinical Behavior of Meningiomas
Authors: Crone Kerry R. , Challa Venkata R. , Kute Timothy E. , Moody Dixon M. , Kelly David L.
Published: May 2010

Meningiomas have a wide range of biological potential and clinical behavior. Histological findings are helpful in recognizing the malignant potential of a given tumor, but often fail to correlate with gross features, liability of recurrence, and extent of associated cerebral edema. To find alternate approaches to improve the correlation between biological and clinical behavior, 20 meningiomas were studied by flow cytometry (FC), an assessment that has been applied to meningiomas previously. Such FC features as DNA index (DI) and proliferative index (PI, %G2 † %S) were correlated with size, location, brain invasion, associated edema, and recurrence. Tumors with severe edema had significantly higher PIs (19.5 ± 4.1) than those with moderate (12.6 ± 4.5) or minimal (8 ± 0) edema (P < 0.05). The PI was greater than 16 in those tumors that recurred (n = 3) or invaded the brain (n = 3). Six tumors were aneuploid (DI, 1.33 ± 0.17; PI, 17.1 ± 5.3). These were uniformly large when compared with the diploid tumors, which were more variable in size. All of the aneuploid tumors were associated with moderate to severe cerebral edema. Two partly psammomatous tumors with high PIs and foci of high cellularity suggesting recent growth were associated with severe edema. One of these exhibited brain invasion. These preliminary data indicate that FC may have a potential use in the clinical management of meningiomas.
Intrasellar Intercarotid Communicating Artery Associated with Agenesis of the Right Internal Carotid Artery: Case Report
Authors: Udzura Masahiko , Kobayashi Hiroo , Taguchi Yoshio , Sekino Hiroaki
Published: May 2010

A 54-year-old man with a right hemiparesis was found to have an intrasellar intercarotid communicating artery associated with agenesis of the right internal carotid artery. Magnetic resonance imaging (MRI) studies demonstrated the spatial relationship of the anomalous artery to the surrounding structures, thus suggesting an embryonic enlargement of the capsular artery as a source of this anomalous artery.
Evaluation of Prognostic Factors in Cerebral Arteriovenous Malformations
Authors: Steinmeier Ralf , Schramm Johannes , Müller Hans-Georg , Fahlbusch Rudolf
Published: May 2010

In a retrospective study of 48 patients who underwent elective surgery for cerebral arteriovenous malformations, a statistical analysis of demographic, clinical, and neuroradiological data was undertaken in order to discover the best predictors of operative morbidity. In addition, the predictive value of different clinical grading systems as applied to this series was compared. All patients had a computed tomographic scan and a positive angiogram before surgery. Complete resection was proven angiographically. The univariate Mann-Whitney-Wilcoxon rank sum test, the Fisher exact test, Spearman's rank correlation coefficient analysis, and multivariate logistic regression were used as statistical methods. Duration of surgery, the development, of either new deficits or an increase in the preoperative neurological signs immediately after surgery, and rehabilitation (as measured by the Karnofsky index) were taken as target variables for the difficulty of operation and for postoperative morbidity, respectively. The largest diameter of the nidus of the arteriovenous malformation, eloquence of the adjacent brain, and deep venous drainage showed the most consistent correlation with these target variables. Intracerebral hematoma and other single factors, such as the age of the patient or localization of the arteriovenous malformation did not affect the outcome. The clinical grading scale of Spetzler and Martin provided better prediction of surgical risks than other proposed systems.
Treatment of Trigeminal Neuralgia by Thermocoagulation, Glycerolization, and Percutaneous Compression of the Gasserian Ganglion and/or Retrogasserian Rootlets: Long-Term Results and Therapeutic Protocol
Authors: Fraioli Bernardo , Esposito Vincenzo , Guidetti Beniamino , Cruccu Giorgio , Manfredi Mario
Published: May 2010

From 1976 to 1986, 681 patients with drug-refractory trigeminal neuralgia (TN)—typical in 641, symptomatic of multiple sclerosis in 23 and of tumor in 10, atypical in 5, and postherpetic in 2—were treated with various percutaneous procedures. Controlled differential thermocoagulation of the gasserian ganglion and/or retrogasserian rootlets was performed in 533 patients; glycerolization of the trigeminal cistern in 32; and compression of the gasserian ganglion by balloon catheter in 159, Results and complications of each procedure are assessed at a mean follow-up of 6.5 years for thermocoagulation, 5 years for glycerolization, and 3.5 years for compression. The following therapeutic protocol is proposed: 1) in TN patients at first operation: a) gasserian compression (or glycerolization, if experience warrants it) is indicated in all cases of typical TN, unless the 3rd division alone is affected; b) in the latter case and in symptomatic TN, we suggest thermocoagulation; 2) in recurrences: a) after glycerolization or gasserian compression, gasserian compression (or glycerolization) is indicated; b) after thermocoagulation or open surgery, thermocoagulation is suggested.
Influence of Anesthetics—Nitrous Oxide in Particular—on Electromyographic Response Evoked by Transcranial Electrical Stimulation of the Cortex
Authors: Zentner Josef , Kiss Ivan , Ebner Alois
Published: May 2010

The influence of anesthetics usually used for neuroleptic anesthesia—nitrous oxide, fetanyl, flunitrazepam, and thiopental sodium—on motor evoked potentials (MEP) was examined in 15 patients during neurosurgical operations on the spinal cord, in 16 patients in traumatic coma, and in 6 healthy volunteers. MEP were recorded from the contralateral thenar and anterior tibial muscles in response to single transcranial electrical stimuli on the motor cortex. Intraoperatively, during neuroleptic anesthesia we found the amplitudes to be reduced to an average of 11% of the preoperative baselines for the thenar potentials, and to 7% of the preoperative baselines for the anterior tibial muscle potentials, despite a maximum stimulus strength of 750 V. A similar reduction of MEP amplitudes was observed in 6 volunteers during breathing of an oxygen/nitrous oxide mixture (34%/66%), whereas fentanyl, flunitrazepam, and thiopental had only a minor effect on MEP. We conclude that with respect to anesthesia-related suppression of amplitudes, an average of 5 to 15 electromyographic responses should be evaluated for intraoperative monitoring of MEP using the technique described here.
Ruptured S1-S2 Disc Presenting with S2 Radiculopathy
Authors: Nabors Michael W. , Cooney F. Donald
Published: May 2010

We report the case of a 61-year-old man in whom numbness developed on the right side of the penis, scrotum, and perineum after he jumped into a swimming pool. Magnetic resonance imaging and a computed tomographic scan disclosed a lesion at S1-S2 impinging on the right S2 nerve root. At surgery, ruptured disc material originating in an area normally occupied by the fixed fibrocartilaginous plate was identified and excised. Postoperatively, the numbness resolved. We discuss a possible cause of the rupturing of the sacral disc and recommended treatment by laminectomy and excision, as in other cases of ruptured disc at other levels of the spinal column.
Progressive Unilateral Hydrocephalus in Adults
Authors: Venkataramana N. K. , Kolluri V. R. Sastry , Swamy K. S. Narayana , Arya B. Y. T. , Das B. S. , Reddy G. N. Narayana
Published: May 2010

Unilateral dilatation of the lateral ventricle in adults is rare. We report 2 cases of unilateral hydrocephalus with obstruction at the foramen of Monro. Both patients presented with symptoms of raised intracranial pressure.
Selective Shunting During Carotid Endarterectomy Based on Two-Channel Computerized Electroencephalographic/Compressed Spectral Array Analysis
Authors: Tempelhoff Rene , Modica Paul A. , Grubb Robert L. , Rich Keith M. , Holtmann Barbel
Published: May 2010

The reliability of selective shunting based on computerized electroencephalographic (EEG) monitoring has not been addressed. In this study, 103 carotid endarterectomies were performed with selective shunting based on a two-channel computerized EEG monitor that processed the on-line, raw electroencephalogram (EEG) to produce a compressed spectral array (CSA). Ischemic EEG events were identified by amplitude attenuation of the raw EEG and/or loss of high-frequency activity on the CSA. Fourteen patients (13.6%) received a bypass shunt, and postoperative neurological examinations showed 97 patients (94.2%) to be intact. A correlation between total (cumulative) ischemic EEG time and the postoperative neurological exam was demonstrated (P < 0.0001). Six postoperative deficits (5.8%) occurred, five in patients whose computerized EEGs demonstrated an ischemic EEG event late during carotid clamping, when it was no longer possible to place a shunt. The sixth deficit was found in a patient whose EEG did not demonstrate any signs of cerebral ischemia. Five of these six new deficits resolved within 12 hours, and only one persisted for 72 hours, when the patient died of a pulmonary embolism (cerebral infarction and mortality rate of 1%). These results appear to demonstrate that two-channel monitoring of both the CSA and the unprocessed (raw) EEG simultaneously can be used as a reliable indicator of whether a bypass shunt is required during carotid cross-clamping in all patients, regardless of their preoperative neurological history or angiographic findings.
Intraspinal Extension of an Air Cyst of the Lung: Case Report
Authors: Andrews David W. , Gamache Francis W. , Weingarten Karen , Haimes Alison B.
Published: May 2010

We report the diagnostic evaluation and treatment of a cystic paraspinal and epidural lesion originally thought to be a neurofibroma or an arachnoid cyst. Intraoperatively, the lesion was found to be an air cyst of the lung that was successfully ligated.
Pituitary Hyposecretion and Hypersecretion Produced by a Rathke's Cleft Cyst Presenting as a Noncystic Hypothalamic Mass
Authors: Wenzel Marc , Salcman Michael , Kristt Donald A. , Gellad Fouad E. , Kapcala Leonard P.
Published: May 2010

A 53-year-old man presented with polydipsia, polyuria, lightheadedness on standing, and syncope. Visual field deficits suggesting left optic tract compression and pituitary dysfunction consisting of diabetes insipidus, hyperprolactinemia, and anterior pituitary insufficiency were diagnosed. On the computed tomography scan, an isodense, ring-enhancing, parasellar mass was localized primarily in the suprasellar region and also extended into the sella. It was believed that the pituitary hormone hypersecretion and hyposecretion were due to hypothalamic dysfunction from the mass which was initially believed to be a craniopharyngioma. At surgery a Rathke's cleft cyst was resected. The unusual presentation of this Rathke's cleft cyst presenting as a hypothalamic lesion is discussed.
Successful Combination Chemotherapy (Cisplatinum, Vinblastine, and Bleomycin) in the Treatment of Medulloblastoma Disseminated by Cerebrospinal Fluid: Case Report
Authors: Asai Akio , Matsutani Masao , Kohno Takeshi , Fujimaki Takamitsu , Takakura Kintomo
Published: May 2010

A case of successful combination chemotherapy using cisplatinum, vinblastine, and bleomycin (PVB therapy) to treat medulloblastoma disseminated by cerebrospinal fluid is presented. In this case, a locally recurrent tumor and several disseminated tumors were seen to decrease in size on CT examinations. Pain in the lower extremities and urinary incontinence improved during three courses of PVB therapy administered during a period of 9 weeks. These results suggest that combination PVB therapy may offer one of the treatments of choice for recurrent or disseminated medulloblastoma.
Intracranial Hypoglossal Neurinoma with Extracranial Extension: Review and Case Report
Authors: Odake Genya
Published: May 2010

A case of neurinoma affecting the intracranial part of the hypoglossal nerve is reported. Symptoms and signs, radiological findings, and operative results of other cases are reviewed. The value of computerized tomography and magnetic resonance imaging in local diagnosis and the feasibility of a one-stage operation for total removal of tumors with extracranial extension are discussed.
Treatment of Fractures of the Vertebral Limbus and Spinal Stenosis in Five Adolescents and Five Adults
Authors: Epstein Nancy E. , Epstein Joseph A. , Mauri Thomas
Published: May 2010

Fractures of the vertebral limbus occur between the vertebral ring apophyses and the cartilaginous rim of the superior or inferior margins of the vertebral end plates. These fractures are typically seen in adolescents or young adults, since fusion in this area is not complete until the ages of 18 to 25. Of 85 cases reported, 24 occurred in adolescents. The authors present the clinical, neurodiagnostic, and surgical management of fractures of the vertebral limbus and coincident segmental spinal stenosis in a group of 5 adolescents and 5 adults. An additional category for fractures of the vertebral limbus is proposed, namely, a lesion that is not confined to the superior or inferior margins of the vertebral end plates, but that spans the full length of the vertebral body.
Castleman's Disease Manifesting in the Central Nervous System: Case Report with Immunological Studies
Authors: Gianaris Peter G. , Leestma Jan E. , Cerullo Leonard J. , Butler Albert
Published: May 2010

Castleman's disease is an uncommon lymphoproliferative disorder that manifests itself as a local or generalized tumor-like condition affecting both lymph nodes and nonnodal tissues, usually in the chest or abdomen. Only two prior examples involving the central nervous system had been reported when this patient was encountered. Very recently, three additional cases have been reported by Severson et al. We report the sixth case of Castleman's disease affecting the central nervous system, which occurred in a 63-year-old woman in whom the diagnosis was made after craniotomy for a mass lesion involving the dura over the frontal regions. Neuroradiological, clinical, and immunopathological characteristics of the case are presented. The lesion was treated with cranial irradiation and the patient is alive and symptom free three years after initial treatment.
The Small Midline Occipital Encephalomeningocele: Definition of a Syndrome
Authors: Schlitt Michael , Williams Powell J. , Bastian Frank O. , Smith Sage
Published: May 2010

An unusual group of encephalomeningoceles is described. Two children were noted at birth to have a raised area of abnormal skin at the occipital midline. Both of these lesions were found to perforate the superior sagittal sinus and to end between the leaves of the falx cerebri, and to contain a small amount of abnormal cerebral tissue with no connection to either occipital lobe. Previous case reports are reviewed; these lesions are true encephalomeningoceles, rather than glial heterotopias. The embryology of such lesions is considered, and likely differs from the much more common occipital encephalocele arising from one or both occipital lobes.
Subependymoma of the Cervical Spinal Cord
Authors: Vaquero Jesús , Martinez Roberto , Vegazo Inmaculada , Pontón Patricia
Published: May 2010

A case of subependymoma of the spinal cord in the cervical region is presented. Our experience with this patient and the seven cases of spinal cord subependymoma previously reported show that this tumor predominates in the cervical region and in males (3:1). Although radical removal is considered the rational goal of treatment, larger experience is necessary to know both the rate of growth and prognosis of subependymomas when these tumors arise within the spinal cord.
Controlled Pressure-Volume Factors in the Enlargement of Intracranial Aneurysms
Authors: Austin George M. , Austin George M. , Schievink Wouter , Williams Richard
Published: May 2010

Pressure-volume relations were investigated on a model aneurysm wall made of elastic tissue and collagen. The model wall had a Young's Modulus of 2 × 107 dynes/cm2, approximating the elastance of fresh aneurysm walls obtained at autopsy. The model wall was fixed over the top of a glass T-tube, 6 mm in diameter. Pressure pulse waves of water or outdated human blood entered at the bottom of the T-tube and exited by way of a controlled resistance, while pressure was monitored by a strain gauge and recorded on an ink writer from the other arm. Incremental increases in systolic pressure produced a nonlinear N-shaped pressure-volume curve. There was an initial linear enlargement in volume with increased pressure until a pressure threshold was reached at a point of high nonlinear compliance. At this point there was an abrupt jump in volume (mean increase = 70 ± 14%) to a new stable equilibrium volume. A further increase in pressure (24 ± 7 mm Hg) could eventually cause aneurysm rupture. This always occurred in the thinner, more compliant part of the wall. With higher pulse rates, the jump in volume occurred at a smaller volume, whereas with thinner aneurysm walls of higher compliance the pressure threshold for a jump in volume was significantly lower. At a higher peripheral resistance there was a higher pressure threshold. The authors suggest that there is one possible mechanism that may occur in the neck of some developing human aneurysms and could explain early and rapid initial growth in size.
Evaluation and Follow-Up of Carotid-Cavernous Fistulas by Transcranial Doppler Sonography: Illustrative Case
Authors: Gomez Camilo R. , Gomez Sandra M. , Yoon Kong-Woo Peter , Kraus Gary E.
Published: May 2010

The availability of transcranial Doppler sonography has resulted in an easy, noninvasive, reproducible, and highly reliable method for evaluating the flow characteristics of carotid-cavernous sinus fistulas. It also allows the follow-up of the effect of different interventional measures, specifically, embolization with detachable balloons. An illustrative case is reported, in which the findings of serial transcranial Doppler sonograms are correlated with findings on computed tomographic scans and angiograms. The impact of our findings on future approaches to the hemodynamic classification of these acquired vascular shunts is discussed.
Temporary Motor and Sensory Paralysis Associated with Intrathecal Administration Of Morphine
Authors: Kleiner Laurence I. , Krzeminski Joseph , Rosenwasser Robert H.
Published: May 2010

We are reporting a temporary, totally reversed motor and sensory paralysis subsequent to the intrathecal administration of 1.6 mg of morphine sulfate. This may represent an event which is not based on medication-induced myelopathy but on cardiovascular changes occurring as a result of pain relief.
Familial Trigeminal Neuralgia: Case Report
Authors: Kirkpatrick Douglas B.
Published: May 2010

Trigeminal neuralgia in its classic form is usually an isolated disease that occurs in sporadic fashion without epidemio-logical or genetic significance. This paper discusses a family with three nontwin sisters, all of whom have classic trigeminal neuralgia occurring in early middle age with symptoms severe enough to require medical and surgical treatment. These three sisters also have one aunt with a history of severe facial pain, although this has not been medically documented. Clustering of such cases in a given family has been reported before, but is rare. The pathophysiological implications of this genetic clustering are discussed.