bluuebunny/crossref_metadata_2025 huggingface dataset:
End-to-End Suture of the Posterior Inferior Cerebellar Artery after the Excision of a Large Aneurysm: Case Report
Authors: Dolenc Vinko
Published: May 2010

A case of a large aneurysm of the left posterior inferior cerebellar artery (PICA) is presented. The ectasia of the PICA was excised, and the artery was reconstructed by end-to-end suture. The PICA proved to be patent. The patient had neither pre- nor postoperative neurological deficit.
Giant Intracranial and Extracranial Meningioma: Case Report and Review of the Literature
Authors: Cech David A. , Leavens Milam E. , Larson David L.
Published: May 2010

Large extracranial extensions of intracranial meningiomas are rare. We report the case of a 63-year-old man with a giant parietal occipital meningioma, which was removed successfully without significant complications. The tumor's total 2600-g mass makes it one of the largest of central nervous system origin ever resected. We detail the problem of dealing with such a tumor and review similar cases.
Partial Hydrocephalus with Chronic Subdural Hematoma
Authors: Yoshimine Toshiki , Hayakawa Toru , Kamikawa Kiyoo , Ohnishi Toshiteru , Ohnishi Toshiteru , Yamamoto Kazumi
Published: May 2010

Two adult patients with unilateral chronic subdural hematomas are reported because of the presence of dilatation of the lateral ventricle opposite the hematoma. In both cases, dilatation was limited to the contralateral atrium and the occipital and temporal horns. The selective dilatation, we believe, is explained on the basis of the anatomy of the skull base and the falx. This phenomenon may contribute to an increase of the supratentorial pressure, originally elevated by the hematoma. This characteristic finding on computed tomographic scans should be regarded as critical in cases of chronic subdural hematoma.
Symptomatic Spinal Stenosis Associated with Ankylosing Spondylitis
Authors: Luken Martin G. , Patel Dushyant V. , Ellman Michael H.
Published: May 2010

Patients with ankylosing spondylitis frequently experience back pain and they have a well-known propensity for spinal fractures, but they rarely manifest motor and sensory nerve root impairment. We recently encountered a patient with ankylosing spondylitis who complained of classical spinal claudication with urinary sphincter dysfunction. Computed axial tomography revealed marked lumbosacral lateral recess and foraminal spinal stenosis that was not evident on the myelogram; at operation the stenosis appeared to be the result of extensive posterior soft tissue ossification. This heretofore unrecognized yet potentially treatable complication of ankylosing spondylitis is discussed.
Familial Occurrence of Cerebellar Hemangioblastomas—Analysis of Five Families
Authors: Yamashita Junkoh , Handa Hajime , Kim Choigon , Kim Sooho
Published: May 2010

Characteristic features of familial cases of cerebellar hemangioblastom a were analyzed on the basis of 54 patients, 32 male and 22 female. In this group there were 7 cases from five affected families. The overall recurrence rate was 33.3% among patients who had been followed for more than 4 years after total removal of the tumor. Recurrence was more common in the familial cases (50%). The average age at the onset of symptoms was younger (23.4 years) in familial cases than in nonfamilial cases (36.2 years) and tended to be even younger (18.9 years) in the second generation of familial cases. These findings suggest that the integration of primitive vasoformative tissues is disturbed more severely in familial cases of cerebellar hemangioblastoma.
Treatment of Cerebrospinal Fluid Shunt Infections with Medical Therapy Alone
Authors: Mates S. , Glaser J. , Shapiro K.
Published: May 2010

Eight of 48 patients with shunt infections were treated with antibiotic therapy only. Seven of the 8 were cured and remained infection-free for at least 1 year. Six of the 7 patients had developed infection within 2 weeks of shunt insertion or revision. Shunt infections that occur soon after operation may have a good cure rate with antibiotics and no surgical intervention.
Malignant Optic Glioma Presenting Radiologically as a “Cystic” Suprasellar Mass: Case Report and Review of the Literature
Authors: Barbarao Nicholas M. , Rosenblum Mark L. , Maitland Charles G. , Hoyt William F. , Davis Richard L.
Published: May 2010

The diagnosis of malignant glioma of the optic nerves and chiasm may be difficult because these rare lesions may mimic other suprasellar lesions. We report a case of glioblastoma multiforme of the optic chiasm in which the appearance of the lesion on computed tomographic (CT) scan was consistent with that of craniopharyngioma or cystic pituitary adenoma. We suggest that malignant optic glioma should be considered in the differential diagnosis of an adult with progressive visual loss of rapid onset, even when ophthalmological examination strongly suggests extrinsic compression of the anterior optic pathways and when the CT scan apparently indicates a cystic mass lesion.
Colloid Cyst of the Third Ventricle Presenting as a Ringenhancing Lesion on Computed Tomography
Authors: Bullard Dennis E. , Osborne Dennis , Cook Wesley A.
Published: May 2010

We report a patient with a colloid cyst of the 3rd ventricle. The computed tomographic scan demonstrated a ringenhancing lesion rather than the classically described homogeneous hyperdense lesion. A brief review of the literature and theoretical explanations for this case are presented.
Pituitary Enlargement and Primary Hypothyroidism: A Report of Two Cases with Sharply Contrasting Outcomes
Authors: Gup Ronald S. , Sheeler Leslie R. , Maeder Michael C. , Tew John M.
Published: May 2010

Primary hypothyroidism may be associated with pituitary enlargement. Two cases of pituitary enlargement with suprasellar extension associated with primary hypothyroidism are presented. In one patient, prompt regression of the pituitary enlargement occurred with replacement doses of L-thyroxine. In the second patient, there was progressive enlargement of the pituitary gland while the patient was on L-thyroxine therapy with documented normalization of serum levels of thyroid-stimulating hormone. We recommend repeat evaluation of all patients with pituitary enlargement that is thought to be secondary to primary hypothyroidism to document regression of pituitary size after L-thyroxine therapy.
Successful Treatment by Lumboperitoneal Shunting of a Spinal Subclavicular Fistula following Thoracotomy
Authors: Katz Sheldon S. , Savitz Martin H. , Osei Clement , Harris Leon
Published: May 2010

A 60-year-old woman with a Pancoast tumor developed a spinal subclavicular fistula after thoracotomy. Pseudomonas meningitis was treated with intravenous cefotaxime before lumboperitoneal shunting. A brief review of the neurosurgical literature on direct and indirect approaches to the closure of cerebrospinal fluid fistulas is presented.
Intracranial Extension and Spontaneous Hemorrhage of a Sphenoid Plasmacytoma
Authors: Harper Lonnie , LeBlanc Hector J. , McDowell James R.
Published: May 2010

A case of intracranial extension of a plasmacytoma of the sphenoid bone is reported. Early symptoms of trigeminal nerve involvement preceded the abrupt onset of coma. Uncal herniation occurred secondary to a large middle fossa mass that bled into the subdural space. Earlier recognition of the intracranial extension would have prompted radiation therapy, which could have obviated the subsequent catastrophic hemorrhage.
Curable Paraplegia Due to Extradural Hematopoietic Tissue in Thalassemia
Authors: Abbassioun Kazem , Amir-Jamshidi Abbass
Published: May 2010

Two patients with β-thalassemia and spinal cord compression due to extradural extramedullary hematopoietic tissue are presented and the related literature is reviewed. This rare complication, once diagnosed, may be treated readily with surgical decompression or radiation. The diagnosis is suggested by evidence of extramedullary hematopoiesis elsewhere and the presence of an extradural lesion, usually in the mid- and lower thoracic region, on myelography and, at times, a paravertebral mass on chest x-ray films. Our findings lend support to the hypothesis that such hematopoietic tissue in the spinal cord vicinity arises from embryonal rests in the extradural areolar tissue of mesodermal origin.
Seizures during the Immediate Postoperative Period
Authors: Kvam David A. , Loftus Christopher M. , Copeland Brian , Quest Donald O.
Published: May 2010

Twenty-three of 538 patients undergoing elective craniotomy had a seizure within 24 hours after operation. The lesion had been located extra-axially in 15 patients and intra-axially in 8 patients. Except for 1 patient who had a parietal craniotomy for an arteriovenous malformation, all patients had a frontal or temporal exposure. Only 5 patients had a previous history of seizures. Adequate levels of anticonvulsant medication were not present in 19 of the 23 patients before operation. No major postoperative metabolic abnormalities were noted in any of the 23 patients. Thirteen of the 23 patients underwent computed tomography to evaluate the etiology of their seizures; none had a significant intracerebral or extracerebral hematoma. This review suggests that an early postoperative seizure is unlikely to be due to a postoperative hematoma or to metabolic abnormality. The most common association in this series was with inadequate anticonvulsant prophylaxis. An approach to postoperative seizure prophylaxis and management is presented.
Familial Brain Tumors
Authors: Challa Venkata R. , Goodman Harold O. , Davis Courtland H.
Published: May 2010

We studied two families in each of which three or more individuals were affected by brain tumors. In the first family, which had no evidence of neurofibromatosis or tuberous sclerosis, a man, his sister, and her son developed histologically proven gliomas; the man's great uncle was historically reported to have died from a brain tumor, but the exact nature of the tumor was not known. In this family two of the tumors were low grade astrocytomas of the cerebrum, whereas the third was a mixed glioma of the cerebellum. Karyotypic analysis of this tumor showed no marker chromosomes. A second family had a history of an unusual concentration of brain tumors. In one patient the tumor was a histologically verified glioma. Four other patients had historically reported brain tumors, the descriptions of which suggested gliomas. Both families showed involvement of individuals in adjacent generations, although in both instances there were skipped generations. Twins, siblings, or parents and children are the kindred groups affected in most other reported families with multiple brain tumors. The mode of inheritance of brain tumors in these two families and recent literature on the conditions associated with familial brain tumors are discussed.
Progressive Change in Cerebral Blood Flow during the First Three Weeks after Subarachnoid Hemorrhage
Authors: Meyer Carl H.A. , Lowe Derek , Meyer Marcia , Richardson Peter L. , Neil-Dwyer Glenn
Published: May 2010

Cerebral blood flow (CBF) was estimated from each cerebral hemisphere by the 133Xe inhalation method. Daily estimates were made during the first 3 weeks after subarachnoid hemorrhage (1265 studies in 116 patients). Some of the patients were taking no drugs. CBF was also studied in 67 normal subjects. The resting CBF was related inversely to age not only for normal subjects but also for patients after subarachnoid hemorrhage (SAH). The CBF fell progressively during the first 2 weeks after SAH and was abnormally low throughout the 3 weeks after hemorrhage. For any 1 day after SAH, those patients who were fully alert had the smallest reduction in CBF. The progressive changes in CBF occurred whether or not an aneurysm was present on angiograms. For aneurysms situated to one side of the midline, the changes in CBF affected both sides of the brain. The progressive decline in CBF was least in those patients who subsequently made the best clinical recovery. Arterial CO2 seemed to influence CBF throughout the 3 weeks after SAH. During the 2nd week, CBF was especially low in SAH patients treated with tranexamic acid. The serial changes in CBF are discussed in relation to current views concerning the timing of operation for ruptured aneurysms.
Subchoroidal Trans-Velum Interpositum Approach to Mid-Third Ventricular Tumors
Authors: Lavyne Michael H. , Patterson Russel H.
Published: May 2010

Our experience with the subchoroidal, trans-velum interpositum approach to mid-3rd ventricular tumors is reviewed, and our operative technique is described. Excellent exposure of the mid-3rd ventricle is gained by opening the foramen of Monro posteriorly after dividing the septal vein and/or the thalamostriate vein from the ipsilateral internal cerebral vein. There has been no morbidity or mortality in eight successive cases. The principal advantage of this technique is that the fornix is preserved and memory function is not at risk.
Superior Sagittal Sinus Thrombosis after Closed Head Injury
Authors: Stringer Lynn W. , Peerless S. J.
Published: May 2010

Superior sagittal sinus thrombosis is a rare but often fatal complication of closed head injury. We present a case diagnosed by computed tomography (CT) and managed with corticosteroids and anticonvulsants with a favorable outcome. The clinical aspects and CT findings of this disease are discussed.
Post-traumatic Acalculous Cholecystitis on a Neurosurgical Service
Authors: Branch Charles L. , Albertson David A. , Kelly David L.
Published: May 2010

Post-traumatic acalculous cholecystitis is a potentially lethal complication that may develop in patients during hospitalization for trauma. Three case reports illustrate that obscuration of many early diagnostic symptoms and signs may make this complication particularly treacherous in the neurosurgical patient. Suspicion should be aroused by unexplained fever, leukocytosis, elevated serum bilirubin and alkaline phosphatase values, and developing intolerance to oral or tube feedings. There may be a rapid progression to signs of an acute abdominal condition. Symptoms are most likely to occur 1 week to 1 month after the episode of trauma. Patients of all ages are susceptible. Diagnosis is best confirmed by noninvasive iminodiacetic acid hepatobiliary scanning accompanied by ultrasound or abdominal computed tomographic scanning. The treatment of choice is emergency cholecystectomy. The cause is most likely multifactorial and is probably related to hypotension, sepsis, or biliary stasis with subsequent cystic duct obstruction. Although this disease is rare, its incidence is apparently increasing, and a high index of suspicion is warranted in the neurosurgeon involved in the care of the biliary tract disorder.
Natural History of Microprolactinomas: Six-Year Follow-up
Authors: Weiss Martin H. , Teal James , Gott Peggy , Wycoff Robert , Yadley Richard , Apuzzo Michael L. J. , Giannotta Steven L. , Kletzky Oscar , March Charles
Published: May 2010

A 6-year follow-up of patients harboring microprolactinomas suggests that few patients (3 of 27) demonstrate significant growth of their tumor during this time. The major hazard for such patients who are not treated seems to be their risk for the development of premature osteoporosis in the face of sustained hyperprolactinemia. The risks of this complication may exceed the risks of early surgical intervention in selected patients. This short term risk of tumor growth (about 10%) must be weighed in the decision about therapeutic endeavors.
Computed Tomographic, Myelographic, and Operative Findings in Patients with Suspected Herniated Lumbar Discs
Authors: Moufarrij Nazih A. , Hardy Russell W. , Weinstein Meredith A.
Published: May 2010

Fifty patients presenting with a suspected herniated lumbar intervertebral disc were evaluated with sector computed tomography (CT). Excluded from this series were patients with prior lumbar laminectomy or a clinical diagnosis of lumbar canal stenosis. Forty-six of the patients also underwent preoperative lumbar myelography. All patients subsequently underwent laminectomy. In 40 patients (80%), CT was positive. In the remaining 10 patients (20%), it was negative; in this group the myelogram correctly predicted the lesion in 8 (80%), Sector CT correctly predicted the nature of the lesion in 24 patients (48%), was incorrect in 14 (28%), and gave incomplete findings in 12 (24%). CT was most accurate when it demonstrated a disc protrusion as the only finding. In this group, sector CT correctly predicted the operative findings in 24 of 25 patients (96%). CT was less accurate when spondylitic compression was diagnosed. This study suggests that sector CT is a useful test in the evaluation of patients with sciatica and that, when a soft herniated disc is demonstrated on CT, myelography may be omitted.
Intraoperative Localization of Subcortical Brain Tumors: Further Experience with B-Mode Real-Time Sector Scanning
Authors: Voorhies Rand M. , Engel Ivy , Gamache Francis W. , Patterson Russel H.
Published: May 2010

Intraoperative ultrasonography is a potentially useful tool for the neurosurgeon faced with the task of finding and removing small subcortical brain tumors. With the B-mode real-time sector scan equipment now available, satisfactory images of the intracranial contents can be obtained. Others have reported obtaining images by applying the transducer directly to the dura mater or cortex. This carries the risk of pressure damage to the brain. Furthermore, the presence of acoustical noise in the region close to the transducer results in poor image resolution in the superficial region of the cortex. To circumvent these two problems, we have used a saline-filled cylinder placed over the craniotomy site to achieve acoustical coupling. This technique also increases the area of cortex visualized by the pie-shaped beam of the sector scan by separating the transducer from the brain surface.
Familial Intracranial Aneurysms, with Two Occurring at the Distal Anterior Cerebral Artery
Authors: Verdura Javier , Resnikoff Samuel , Rosenthal Jaime , Cardenas Juan
Published: May 2010

Familial aneurysms of the distal anterior cerebral artery are a neurosurgical rarity. We report a family with four of its members (a mother and three sons) suffering from subarachnoid hemorrhage secondary to ruptured aneurysms, two of them being of the distal anterior cerebral artery. There was no evidence of endocarditis, septic emboli, coarctation of the aorta, or trauma. There was no family history of Marfan's syndrome, polycystic kidney, or hereditary connective tissue disorder. We believe that there has been no report in the neurosurgical literature of familial cases of distal anterior cerebral artery aneurysms.
Proposed Operation for Occipital Neuralgia: C-2 and C-3 Root Decompression
Authors: Poletti Charles E.
Published: May 2010

The common association of occipital neuralgia with post-traumatic cervical arthritis raises the question of whether some cases of occipital neuralgia are due to delayed C-2 or C-3 root entrapment. This hypothesis led to surgical exploration of the C-3 and C-2 roots in a young patient with post-traumatic arthritic occipital neuralgia. The abnormal operative findings and resolution of the neuralgia after C-3 foraminal and C-2 fascial root decompression lead to the tentative proposal that some cases of occipital neuralgia represent a root entrapment syndrome amenable to neurosurgical decompression.
Size of Intracranial Aneurysms
Authors: Kassell Neal F. , Torner James C.
Published: May 2010

Intracranial aneurysms are common lesions, occurring in as many as 2% of the age-corrected population of North America. Most aneurysms are small and innocuous, but some will enlarge and rupture. The clinical frequency of intact aneurysms has been increasing as a result of computed tomographic scanning and digital subtraction angiography, and this trend can be expected to accelerate in the future. Intact aneurysms are an important neurosurgical problem. Once an aneurysm ruptures, there is an associated 50 to 60% overall mortality and morbidity. In contrast, surgical correction of an unruptured aneurysm in skilled hands carries a mortality and morbidity of approximately 3%. Obviously, the optimal time for correction of aneurysm is before it ruptures. For effective management of patients with intact aneurysms, prognostic criteria for rupture are clearly needed. Aneurysm size is both theoretically and empirically a key prognostic factor for rupture. However, the critical size at which an aneurysm becomes hazardous is not known. The purpose of this investigation was to study the size of ruptured aneurysms in an attempt to infer the behavior of unruptured aneurysms. The angiographic size of aneurysms in the 1092 patients admitted to the Cooperative Aneurysm Study between 1970 and 1977 was measured. The average maximal diameter was 8.2 + 3.9 (SD) mm, and the median diameter was 7.0 mm. Seventy-one per cent of the sacs were smaller than 10 mm and 13% were less than 5 mm in diameter. Middle cerebral artery aneurysms were the largest and anterior communicating artery aneurysms were the smallest. These data suggest that aneurysms less than 1 cm in diameter are hazardous and that operation should be considered for lesions more than approximately 5 mm in diameter. Additional prognostic factors for rupture are clearly needed.
Improved Outcome in the Treatment of Trigeminal Neuralgia by Percutaneous Stereotactic Rhizotomy with a New, Curved Tip Electrode
Authors: Tobler William D. , Tew John M. , Cosman Eric , Keller Jeffrey T. , Quallen Barbara
Published: May 2010

Percutaneous stereotactic rhizotomy (PSR) as a method of treatment of trigeminal neuralgia has gained popularity in recent years as techniques of electrode placement and lesion production have improved. However, undesirable side effects including major and minor paresthesias, trigeminal motor root weakness, diplopia, and keratitis continue to occur even in cases where the neuralgia is treated successfully. In an attempt to improve treatment further, we have developed an electrode with a flexible curved tip for PSR of the trigeminal nerve. Once the electrode and the cannula are positioned in the retrogasserian portion of the trigeminal nerve with a standardized technique, manipulation of the electrode about its 360° axis readily enables an infinite variety of position adjustments of the electrode tip. This capability enables easier and more precise electrode placement and lesion production. Undesirable lesions of the motor root may be avoided. A curved electrode has been used in 150 patients. The incidence of masseter weakness is 7.3% in this series, compared to 24% in our series of 700 patients treated with a straight electrode. The incidence of undesirable paresthesias has decreased from 27% to 10.6%. The immediate results obtained in patients with the curved electrode have improved. Excellent results (no pain, no side effects) have been achieved in 88% of patients, in contrast to 76% treated with the straight electrode. Application of stereotactic principles and the use of the curved electrode have enhanced the appeal of PSR for the treatment of trigeminal neuralgia.
Spinal Arachnoiditis Ossificans: Case Report
Authors: Lynch Carlos , Moraes Glória
Published: May 2010

A case of spinal arachnoidits ossificans is presented and discussed. This is a rare pathological finding. A review of the pertinent literature is given. Laminectomy and removal of the calcification was followed by resolution of the neurological deficit.
Epidural Myxoma Causing Compression of the Cauda Equina: A Case Report
Authors: Bell William O. , Gill Amarjit , Babiak Taras , Patterson Russell H.
Published: May 2010

A unique case of a patient with an epidural myxoma arising at L-3, L-4 presented with a history mimicking lumbar spinal stenosis. Tumor removal with decompression of the cauda equina was curative.
Primary Choroid Plexus Papilloma of the Cerebellopontine Angle
Authors: Chan Richard C. , Thompson Gordon B. , Durity Felix A.
Published: May 2010

A case of choroid plexus papilloma of the cerebellopontine angle, extending from the upper cervical region to the level of the tentorial notch, in a 50-year-old woman is presented. The differential diagnosis of tumors in the cerebellopontine angle and the role of surgical treatment vs. radiation therapy are discussed.
Barbiturate Therapy in Uncontrolled Intracranial Hypertension
Authors: Rea Gary L. , Rockswold Gaylan L.
Published: May 2010

From July 1978 to September 1981, 27 patients from a group of 210 patients with severe head injuries developed uncontrolled intracranial hypertension despite intensive medical and surgical management. These 27 patients were considered appropriate candidates for barbiturate therapy. Abnormal posturing or flaccidity was present in 70%; of the patients, and 41%; had bilaterally fixed pupils. Twenty-five of 27 patients had mass lesions requiring operation. Of the 15 patients who responded to barbiturate therapy with normalization of intracranial pressure for 24 hours, 5 died (33%; mortality). Nine of the 12 patients who did not respond to the barbiturate therapy died (75%; mortality). The total mortality in this group of 27 patients was 52%;. Of the survivors, 69%; had a recovery classified as good recovery/moderate disability, and 31%; were in a severe disability/vegetative state. The morbidity and mortality in these patients is high, but comparisons with previous studies show that this is a selected group of severe head injuries with a high percentage of poor prognostic indicators. Our experience suggests that barbiturates can be effective in lowering intracranial pressure in patients with otherwise unresponsive intracranial hypertension and, by doing so, may decrease the mortality in a group of patients considered untreatable by the usual therapeutic modalities.
Evaluation of Cervical Spine Surgery by Postoperative Myelography
Authors: Fager Charles A.
Published: May 2010

After spontaneous remission of nerve root compression, a myelographic defect may persist. Similarly, myelopathy may remain nonprogressive for long periods despite appreciable myelographic deformity. Although operation may arrest or improve the symptoms of cervical disc lesions and spondylosis, the ultimate confirmation that entrapped neural elements have been relieved permanently can only be provided by postoperative myelography. Preoperative and postoperative myelography documents the significant improvement that can be achieved by using posterolateral and posterior approaches to the cervical spine in patients with nerve root or spinal cord compression. The results in this group of patients were achieved with none of the disadvantages or complications of cervical spine fusion or of the interbody removal of cervical disc tissue, also leading to cervical fusion.
Traumatic Paraplegia in Children without Contiguous Spinal Fracture or Dislocation
Authors: Walsh John W. , Stevens David B. , Young Byron A.
Published: May 2010

Traumatic paraplegia in children is uncommon and, in almost half of these injuries, no contiguous fracture or dislocation of the spine is found. This report presents eight such cases, three in detail. Most of the children were injured in motor vehicle accidents and sustained thoracic level injuries with a permanent loss of neurological function caudal to the injury. The clinical presentation and radiological diagnosis are reviewed. Four mechanisms of injury have been proposed: transient vertebral subluxation, transient disc herniation, traction and stretching of the spinal cord, and vascular compromise with infarction. Unless extramedullary spinal cord compression is present, laminectomy is not useful.
Cervical Spinal Cord Lipoma with Extension into the Posterior Fossa
Authors: White William R. , Fraser Richard A. R.
Published: May 2010

This communication describes a patient with an intradural lipoma that occupied the entire cervical canal and extended into the 4th ventricle. The diagnosis was made preoperatively by use of computed tomography of the head and the spine.
Surgical Treatment of Incidental Intracranial Aneurysms
Authors: Wirth F. P. , Laws E. R. , Piepgras D. , Scott R. M.
Published: May 2010

A 6-year retrospective analysis of incidental intracranial aneurysm surgery was conducted at 12 medical centers (1975-1981). The surgical facilities and techniques were comparable at the institutions surveyed. From a total of 1671 aneurysms operated upon, 119 in 107 patients were unruptured and were discovered incidentally. Among these 107 patients, there was no operative mortality. Operative morbidity occurred in 7 cases (6.5%). Surgical treatment of large aneurysms in less accessible locations incurred the greatest operative morbidity. Presenting symptoms of cerebral ischemia seemed to be associated with increased operative morbidity, whereas repair of aneurysms incidental to other ruptured aneurysms had a uniformly low morbidity. These surgical results compare favorably with the risks of hemorrhage from unruptured intracranial aneurysms as defined by recent reports. The low morbidity without mortality supports a recommendation for surgical management of incidental aneurysms in the anterior circulation at centers equipped for modern aneurysm surgery.
Temporary Clipping during Early Operation for Ruptured Aneurysm: Preliminary Report
Authors: Ljunggren Bengt , Säveland Hans , Brandt Lennart , Kågström Erik , Rehncrona Stig , Nilsson Per-Erik
Published: May 2010

Temporary arterial occlusion was performed in 16 patients undergoing early aneurysm operation. Ten patients had a ruptured middle cerebral artery (MCA) aneurysm, and 6 had a ruptured anterior communicating artery aneurysm. Premature aneurysm rupture during operation necessitated temporary arterial occlusion in 10 patients. In 5 patients, temporary arterial occlusion was performed to facilitate dissection of the aneurysm. In 1 patient with a large MCA aneurysm, temporary occlusion was performed to provoke collapse of the completely exposed aneurysm sac, thus making clipping of the base possible. The results do not indicate that temporary occlusion by the standard aneurysm clips now in general use leads to angiographically detectable arterial wall changes or increased thromboembolic complications. Temporary clipping of the MCA proximal to the perforating arteries may be well tolerated for up to 20 minutes during early aneurysm operation. Temporary occlusion of one or both anterior cerebral arteries or temporary pericallosal clipping need not unconditionally lead to disastrous consequences if rendered necessary during aneurysm operations performed in the acute stage.
Ipsilateral Symptoms Caused by an Arteriovenous Malformation of the Second or Supplementary Sensory Area of the Island of Reil
Authors: Schneider Richard C. , Crosby Elizabeth
Published: May 2010

A report of a patient with an arteriovenous anomaly stresses the correlation of clinical findings with a neuroanatomical basis for ipsilateral sensory symptoms. The significance of the second or supplementary motor and sensory patterns existing in the island of Reil, as demonstrated by the experimental work of Crosby and Augustine, is presented. At present, the evidence is that the discharges from the island of Reil are through the extrapyramidal system, a part of the ansa lenticularis system. The actual anatomical basis for such ipsilateral symptoms should be sought in more patients who are perhaps often designated as “hysterical” because they do not fit the much more commonly known pattern of contralateral symptoms.
The Role of Intraoperative Ultrasound in Neurosurgery
Authors: Grode Marshall L. , Komaiko Mitchell S.
Published: May 2010

High resolution real time intraoperative ultrasound was used in a number of cases to identify, localize, and characterize intracranial abnormalities. Five case reports illustrate the advantage of this technique during neurosurgical operative procedures.
Acute Operation in Cases of Middle Cerebral Artery Occlusion
Authors: Gagliardi Rolando , Benvenuti Lucia , Guizzardi Giancarlo
Published: May 2010

The authors describe their personal experience with middle cerebral artery embolectomy performed in four patients within 6 hours after the start of clinical symptoms. The work is of a preliminary nature. No conclusion can be drawn as to the ultimate value of this treatment, and further clinical trials seem justified.
Internal Metal Plate Fixation Combined with Anterior Interbody Fusion in Cases of Cervical Spine Injury
Authors: Bremer Alfonso M. , Nguyen Tai Q.
Published: May 2010

The authors report their experience with the use of a modified method of internal metal plate fixation combined with anterior interbody fusion in six patients with an unstable lower cervical spine. All of the patients had sustained severe cervical spine injuries in accidents. In most of the cases, the operation was carried out at 1 to 4 weeks after injury. The insertion of the metal plate was very simple and maintained the block bone graft in satisfactory position. This alternative method of internal fixation of the cervical spine was not associated with morbidity, allowed very early mobilization, and shortened the hospital stay.
Spontaneous Regression of a Dural Arteriovenous Malformation
Authors: Olutola Segun P. , Eliam Miguel , Molot Michael , Talalla Andrew
Published: May 2010

The case of a 50-year-old man with a supratentorial dural arteriovenous malformation (AVM) associated with intracerebral hemorrhage is reported. Angiographically confirmed spontaneous regression of the AVM occurred without any form of surgical intervention. A possible mechanism of spontaneous closure of the AVM is offered.
Intracranial Subdural Hematoma after Lumbar Myelography
Authors: Dohrmann Peter A. , Elrick William L. , Siu Kevin H.
Published: May 2010

Two cases of intracranial subdural hematoma after lumbar myelography are reported. This complication should be considered in patients who complain of prolonged headache or who develop neurological signs after lumbar puncture.
Cerebellopontine Angle Lipoma: A Review
Authors: Leibrock Lyal G. , Deans William R. , Bloch Soloman , Shuman Robert , Skultety Miles F.
Published: May 2010

Lipomas located in the cerebellopontine angle(CPA) have rarely been reported. With the advent of computed tomographic scanning and more sophisticated physiological diagnostic techniques, CPA lipomas are being reported more frequently. This paper reviews the world's literature on this lesion and summarizes the symptoms and signs, diagnostic studies, pathology, and surgical results. Recommendations regarding the therapy of this lesion are presented.
Femoral Neuropathy and Retroperitoneal Hemorrhage
Authors: Mastroianni Patrick P. , Roberts Melville P.
Published: May 2010

A case of femoral neuropathy secondary to psoas muscle hematoma in a patient on warfarin sodium anticoagulation therapy is presented. Computed tomography was used to establish the diagnosis. The literature is reviewed with regard to the pathophysiology, clinical presentation, and therapy of this case. Surgical decompression is suggested to shorten the recovery period and minimize residual neurological deficit.
Large Intramedullary Neurofibroma of the Conus Medullaris: Case Report
Authors: Young Henry A. , Robb Peter , Hardy David G.
Published: May 2010

A case of a very large intramedullary neurofibroma of the conus medullaris extending over 31/2 segments is reported. The tumor was successfully treated by midline myelotomy and radical excision with no exacerbation of the preoperative neurological deficit. Intramedullary neurofibroma is extremely rare, accounting for less than 1% of spinal neurofibromas. Myelotomy and radical excision under the operating microscope are recommended in such cases.
An Intramedullary Ependymal Cyst in a 71-Year-Old Woman
Authors: Rousseau Marc , Lesoin Francis , Combelles Guy , Krivosic Yvan , Warot Pierre
Published: May 2010

An intraspinal ependymal cyst of the thoracolumbar spinal cord was found in a 71-year-old woman with a history of right side abdominal pain since the age of 18. The late discovery of the cyst is related to the extremely slow evolution of this type of cyst in the absence of spinal trauma. Etiopathogenic problems are discussed after a review of the literature.
Epidural Hematoma Communicating with Cephalhematoma in a Neonate
Authors: Aoki Nobuhiko
Published: May 2010

The author reports a unique case of a neonate with a depressed skull fracture detected immediately below a cephalhematoma complicated with an epidural hematoma. The epidural hematoma communicating with the cephalhematoma through a depressed skull fracture disappeared after the cephalhematoma was punctured for aspiration, and the depressed fracture reduced spontaneously 6 months thereafter.
Hemangiopericytoma of the Pituitary Fossa: Case Report
Authors: Mangiardi John R. , Flamm Eugene S. , Cravioto Humberto , Fisher Boguslav
Published: May 2010

A case of hemangiopericytoma presenting as a sellar and suprasellar mass is reported. Although this is the first report of this tumor in such a location, it appears similar to hemangiopericytomas found in other locations.
Acute Bilateral Extradural Hematomas in a Case of Osteogenesis Imperfecta Congenita
Authors: Pozzati Eugenio , Poppi Massimo , Gaist Giulio
Published: May 2010

Acute bilateral extradural hematomas occurred after apparently trivial trauma in a patient suffering from osteogenesis imperfecta congenita. Factors influencing the development of this dramatic complication are peculiar to this rare disorder of bone and connective tissue development and include bony weakness, increased vascular fragility, and possible coagulopathies
Spinal Meningoceles in Association with Neurofibromatosis
Authors: O'Neill P. , Whatmore W. J. , Booth A. E.
Published: May 2010

Three cases of spinal meningocele found in association with neurofibromatosis are reported. Each case occurred at a different spinal level. The literature is reviewed.
Mechanisms of Hydrocephalus in Cerebral Cysticercosis: Implications for Therapy
Authors: Estañol Bruno , Kleriga Enrique , Loyo Mauro , Mateos Humberto , Lombardo Luis , Gordon Felipe , Saguchi Andrés Félix
Published: May 2010

Patients with hydrocephalus secondary to cerebral cysticercosis are a highly heterogeneous group. The mechanisms of hydrocephalus in these patients are multiple. Intraventricular cysts may be found in the 3rd and 4th ventricles, the sylvian aqueduct, and the foramen of Monro. Intraventricular cysts can be suspected when the 3rd and 4th ventricles or aqueduct remain enlarged despite shunting. Intraventricular contrast medium demonstrates the presence of the parasites. The intraventricular cysts should be removed surgically. Hydrocephalus due to cisternal cysticercosis can be diagnosed by isotope cisternography. These patients should receive shunts, but the long term prognosis is probably poor. Guidelines for the management of hydrocephalus due to cysticercosis are suggested.
Hemifacial Spasm: Treatment by Microsurgical Facial Nerve Decompression
Authors: Loeser John D. , Chen James
Published: May 2010

The literature on hemifacial spasm and its surgical therapy is reviewed, and the authors' experiences with 20 patients are described. Vascular cross compression of the facial nerve adjacent to the brain stem is seen in 90% of the surgical patients. Mobilizing the offending vessel will cure or significantly improve approximately 80% of the patients. Complications occur in 25% of the patients and usually involve decreased hearing or facial weakness. Mortality is virtually zero, and this operation is vastly superior to any other medical or surgical therapy for hemifacial spasm. The pathophysiology is not yet understood.
Experience with Surgical Decompression of the Arnold-Chiari Malformation in Young Infants with Myelomeningocele
Authors: Park Tae Sung , Hoffman Harold J. , Hendrick Bruce E. , Humphreys Robin P.
Published: May 2010

Forty-five infants with myelomeningocele in whom hydrocephalus was absent or adequately controlled developed signs and symptoms of the Arnold-Chiari malformation before the age of 3 months. All of them underwent laminectomy and opening of the dura mater for hindbrain decompression. The clinical presentation included swallowing difficulty, apneic episodes, stridor, bronchial aspiration, arm weakness, and opisthotonos. Within 2 weeks of the initial clinical presentation, the neurological status of 14 patients (31%) deteriorated dramatically and culminated in irreversible neurological deficits. In all patients, compression of the brain stem occurred in the spinal canal. A transverse dural band constricting the dural sac at the C-1 level was noted in 41% of the patients, and a mild degree of arachnoidal adhesion was noted in 23%. The lowermost level of the cerebellar tongue or medullary kink was located at C-1 to C-4 in 28 cases and at C-5 to T-1 in 17 cases. Twenty-eight (62%) of the patients were alive and 17 (38%) had died at the last follow-up assessment. All survivors showed improvement of their overall neurological function. Twenty-four made a complete recovery. The majority of deaths were attributed to respiratory failure. Early recognition of symptoms and prompt decompressive laminectomy are essential for successful management of the Arnold-Chiari malformation in infants.
Colonic Complications of Ventriculoperitoneal Shunts
Authors: Abu-Dalu Khalil , Pode Dov , Hadani Moshe , Sahar Abraham
Published: May 2010

Late perforation of the large bowel by the abdominal catheter of a ventriculoperitoneal (VP) shunt is extremely rare. Four of the five reported patients subsequently died. We report here three patients who presented with this complication and were treated successfully. Bowel perforation by a VP shunt catheter should be considered when a shunt infection is secondary to gram-negative enteric organisms. It can occur without evidence of peritonitis, and the abdominal catheter can be removed percutaneously, thus avoiding a laparotomy.
Simple Plastic Stereotactic Unit for Use in the Computed Tomographic Scanner
Authors: Levy Walter J.
Published: May 2010

The marriage of computed tomography (CT) and stereotactic surgery offers an opportunity to provide sophisticated and effective treatment to discrete areas of the brain. An important part of this capability is the development of stereotactic frames that are compatible with the CT scanner, i.e., that do not degrade the CT image. A number of technically elegant and ingenious stereotactic frames have been reported. However, they have the drawback of technical complexity and, particularly, great exposure. We are reporting a simple ball and socket skull-mounted stereotactic device that allows solid fixation of probes for use in brain needle biopsies, ventricular catheterization, and similar activities.
Intratemporal Schwannoma of the Facial Nerve
Authors: Tew John M. , Yeh Hwa-Shain , Miller Gale W. , Shahbabian Set
Published: May 2010

Two patients with schwannomas that originated from the region of the geniculate ganglion of the facial nerve are reported. They presented with progressive facial nerve paralysis and variable disturbance of hearing. Computed tomograms demonstrated a mass lesion eroding the temporal bone (petrous portion) and extending into the middle fossa. The treatment consisted of complete excision of the tumor, and a hypoglossal-facial nerve anastomosis. Computed tomography should be performed on all patients with facial palsy of a progressive nature. Early diagnosis and surgical treatment of facial schwannoma should permit preservation of function of the facial and the acoustic nerves.
Extracranial-Intracranial Arterial Bypass and Basilar Artery Ligation in the Treatment of Giant Basilar Artery Aneurysms
Authors: Hopkins L. N. , Budny James L. , Castellani Daniel
Published: May 2010

Two patients with giant aneurysms of the basilar artery treated with prophylactic extracranial-intracranial arterial bypass (EIAB) to the rostral brain stem before basilar artery ligation are presented. In both cases, the bypass provided considerable collateral flow to the upper basilar, posterior cerebral, and superior cerebellar arteries. Basilar artery ligation has been shown to be an effective, albeit dangeours, means of treating giant aneurysms of the basilar artery. The risk of significant brain stem ischemia after ligation is at least 30%. EIAB to the rostral brain stem should be considered whenever basilar artery ligation is performed, especially in cases where angiography demonstrates poor collateral circulation to the distal basilar artery.
Stereotactic Aspiration of a Brain Stem Hematoma
Authors: Beatty Robert M. , Zervas Nicholas T.
Published: May 2010

A medical student developed a progressive mesencephalic lesion found to be cystic in nature by computed tomographic (CT) scanning. Stereotactic aspiration of a pontomesencephalic hematoma was carried out twice, and the patient recovered. Angiography and CT scanning demonstrated a vascular lesion compatible with a venous angioma.
Evoked Potentials in Trigeminal Neuralgia
Authors: Bennett M. H. , Jannetta P. J.
Published: May 2010

Trigeminal evoked potentials and sensory thresholds in response to maxillary gum stimulation were obtained in patients with a complaint of unilateral face pain. The patients and the volunteer, normal control groups had undergone no prior surgical or other procedures involving cranial or cervical structures. For statistical purposes, patient data were analyzed with respect to the diagnostic classification of classical trigeminal neuralgia, atypical trigeminal neuralgia, or other face pain states in which the pain extended beyond the trigeminal nerve distribution. Latencies of trigeminal evoked potentials on the affected side were significantly increased (compared to normal control group responses) in patients with classical but not in those with atypical trigeminal neuralgia nor other face pain syndromes. All three patient groups had statistically significant threshold elevations on the affected side compared to the unaffected side. A high level of significance for this test was obtained for the classical trigeminal neuralgia group. Ratings for patients based upon the preoperative electrophysiological findings were highly correlated with long term results of microvascular decompression of the 5th nerve root for classical, but not for atypical trigeminal neuralgia patients. These results support the view that atypical and classical trigeminal neuralgia symptom complexes are caused by different types of physiological dysfunction and that classical trigeminal neuralgia is associated with compression of the trigeminal nerve root. It was suggested that the rating system may be a useful, objective, clinical adjunct in evaluating patients with classical trigeminal neuralgia.
Management and Outcome of Pineal Region Tumors
Authors: Hitchon P. W. , Abu-Yousef Monzer M. , Graf Carl J. , Turner Donn M. , VanGilder John C.
Published: May 2010

The management and outcome of 45 patients with tumors in the pineal region are reviewed. The overall male to female ratio was 2:1, and over one-half of the patients presented during the 2nd decade of life. Sixteen of the 21 survivors are presently gainfully employed and suffer only minor deficits. Two of 3 survivors in whom the lesion was biopsied harbored germinomas, while the third had an epidermoid. Among the 18 nonsurvivors, all of whom died of their tumors, 15 succumbed within 2 1/2 years of hospital admission. Twelve of the 13 nonsurvivors in whom histological confirmation was obtained by operation or autopsy had malignant tumors. Computed axial tomography was helpful in making the diagnosis of tumor type in 7 of the 11 cases with confirmed pathology. Cerebrospinal fluid cytology disclosed malignant cells in 4 of 11 patients with proven pineal malignancy. Irradiation and shunting were performed in nearly all survivors and in a little over one-half of the nonsurvivors. Where noninvasive studies are equivocal for malignancy, biopsy may be indicated.