bluuebunny/crossref_metadata_2025 huggingface dataset:
Gram-negative bacillary meningitis in neurosurgical patients
Authors: Mombelli Giorgio , Klastersky Jean , Coppens Lyne , Daneau Didier , Nubourgh Yves
Published: May 2009

✓ The authors report 34 cases of Gram-negative bacillary meningitis related to traumatic cranial lesions or neurosurgery observed between 1973 and 1980 at two neurosurgical units (Institut J. Bordet, Brussels, and Inselspital, Bern). As a typical nosocomial infection, meningitis developed after prolonged hospitalization in most patients, and was mainly due to highly resistant organisms, such as P. aeruginosa and Klebsiella sp. At least 65% of the patients were colonized with the pathogen responsible for the meningitis before the onset of the infection. Ventriculitis, including four cases of ventricular empyema, complicated meningitis in all the 17 patients in whom a ventricular tap was performed. The results of treatment were unsatisfactory. Fifty percent of the patients were cured of their infection, but only 30% survived; 15% of the patients died within 48 hours following diagnosis.

The optimum treatment of postsurgical Gram-negative meningitis remains in doubt. The choice of initial antibiotics should take into account the sensitivity patterns of colonizing microorganisms. Chloramphenicol is ineffective against most pathogens commonly involved in this infection. Intrathecal aminoglycosides may fail in the presence of ventriculitis. Intraventricular aminoglycosides are probably justified in critically ill patients. The role of the newer cephalosporins and of co-trimoxazole remains to be defined.
Extradural hematoma of the posterior cranial fossa
Authors: Garza-Mercado Román
Published: May 2009

✓ Extradural posttraumatic posterior fossa hematoma is a rare condition estimated to complicate about 0.3% of all craniocerebral injuries, and represents 4% to 12.9% of the entire group of extradural hematomas. Seven cases of posterior fossa extradural hematoma (PFEDH) are presented. There were four males and three females. One case occurred in an adult, the remaining six cases in patients 16 years of age or younger, two of whom were infants. In each case the hematoma resulted from a blow to the posterior part of the head. Each patient showed local evidence of trauma to the scalp, and a radiographic appearance of an occipital linear fracture crossing the path of the torcular Herophili or the transverse sinus. The clinical picture varied. Three patients suffered immediate transient unconsciousness. Three others suffered sudden respiratory arrest after a seemingly stable course of several hours in the hospital, but responded well to resuscitation maneuvers. Computerized tomography scans were obtained in three patients; in three others no specialized neurodiagnostic studies were feasible; in one patient, precise diagnostic documentation was achieved by Conray ventriculography. All seven patients were operated on and all survived. Two patients had associated surgical intracranial lesions: an underlying subdural hygroma of the posterior fossa in one, and a contralateral supratentorial temporal subdural hematoma in the other. Six patients have returned fully to their previous activities. One patient is steadily improving.
Spontaneous intracerebral hematoma in carotid-cavernous fistula
Authors: Turner Donn M. , Vangilder John C. , Mojtahedi Saeid , Pierson Eric W.
Published: May 2009

✓ Spontaneous intracerebral hematoma associated with carotid-cavernous fistula is rare. Three new cases are presented. In each, the hemorrhage originated in the vicinity of localized intracranial venous engorgement, as demonstrated by cerebral angiography. Rupture of one or several of the distended venous channels from increased back-flow is postulated as the etiology of the intraparenchymal hematomas.
Intracranial trigeminal nerve granular cell myoblastoma
Authors: Rao T. Vasudev , Puri Randhir , Reddy G. N. Narayana
Published: May 2009

✓ The clinicopathological features of an unusual granular cell myoblastoma involving the fifth cranial nerve are presented. Evidence incriminating the Schwann cell as the source of the granular cell is also discussed.
Unilateral hyperostosis frontalis interna
Authors: Hasegawa Takeshi , Ito Haruhide , Yamamoto Shinjiro , Haba Katsuhiko , Murata Hideaki
Published: May 2009

✓ The authors describe a case of atypical unilateral prominent hyperostosis frontalis interna in a 50-year-old Japanese woman with psychiatric symptoms. Radiological, computerized tomographic, operative, and histological findings of this rare case are presented.
Current concepts of bacterial infections of the central nervous system
Authors: Garvey Glenda
Published: May 2009

✓ Investigative work continues to provide guidance toward more rational management of bacterial meningitis and bacterial brain abscess. An increased understanding of the host's response in cases of bacterial meningitis has established that diffusibility of an antibiotic into the cerebrospinal fluid (CSF) is necessary, but is not sufficient for microbial cure. The antibiotic must also have a bactericidal effect on the pathogen. Meningitis after neurosurgery may be caused by Gram-negative aerobic bacilli. In some of these cases the newer cephalosporin antibiotics may be a useful advance. Meningitis complicating ventricular CSF shunts presents a paradigm for the problem of eradicating foreign body-related infections. Studies of the interaction of the host, the organism, and the shunt material offer some explanation for the limited efficacy of antibiotics observed in this setting. There have been advances in microbial definition of bacterial brain abscess. The identification of Bacteroides fragilis as a pathogen in certain brain abscesses has established a role for a newly available antibiotic, metronidazole. The study of the pathological distinction between cerebritis and frank abscess is clarifying two clinical characteristics of brain abscess: the limited success of antibiotic treatment and the increase in intracranial pressure. Computerized tomography has offered a valuable clinical “look” at brain abscesses; however, there are still problems in correlating the scan images with the evolving pathogical process.
Presence of immunosuppressive factors in brain-tumor cyst fluid
Authors: Kikuchi Kenji , Neuwelt Edward A.
Published: May 2009

✓ The present investigation was conducted to examine the effects upon normal lymphocyte activation of the addition of brain-tumor cyst fluid or cerebrospinal fluid (CSF) to an in vitro culture system. It was believed that factors present in these fluids may play a role in local and systemic immunosuppression in brain-tumor patients. The authors evaluated the effect of the cyst fluid, CSF, and serum from eight patients with brain tumors (one astrocytoma, five glioblastoma multiforme, one medulloblastoma, and one microglioma) on mitogen-stimulated lymphocyte function as measured by 3H-thymidine incorporation, cell size distribution, and cellular proliferation. Lymphocytes from normal volunteers were incubated for 90 hours in culture medium with 10% pooled human serum, mitogens (phytohemagglutinin, concanavalin A, and pokeweed mitogen), and a range of volumes of cyst fluid or CSF from the tumor patients. Significant suppression of mitogen-induced activation of the lymphocytes was demonstrated in the presence of cyst fluid from five out of six patients, but the mitogen response was only minimally affected by the addition of the CSF from these patients to the culture medium. The suppression of lymphocyte activation by cyst fluid was directly proportional in several cases to the concentration of the cyst fluid. The total protein, albumin, and immunoglobulin (Ig) concentrations in the cyst fluids were observed to roughly correspond to the serum levels and were much higher than in CSF. These studies suggest that brain-tumor cells locally produce lymphocyte-suppressive factors which may then be released into blood. Preliminary characterization of the suppressive factor(s) responsible for the inhibition of lymphocyte function indicates that they are non-dialyzable and do not appear to be an IgG.
Intravenous digital subtraction angiography in the assessment of patients for carotid endarterectomy
Authors: Kaye Andrew H. , Little John R. , Bryerton Bernadine , Modic Michael
Published: May 2009

✓ Preoperative intravenous digital subtraction angiography (IV DSA) was compared with the operative findings in 54 patients who underwent a total of 57 carotid endarterectomies, to evaluate the accuracy of preoperative IV DSA in predicting the lesion found at surgery. Four studies early in the series were technically unsatisfactory, leaving 50 patients with 53 procedures for evaluation. Severe carotid artery stenosis was accurately predicted in all cases. Deep ulceration in the absence of severe carotid stenosis was reliably shown by IV DSA, although it was not reliably demonstrated by either IV DSA or carotid angiography if severe stenosis was also present. As severe carotid stenosis or deep ulceration are the major radiological indications for carotid endarterectomy, the authors have found that technically satisfactory IV DSA is an adequate preoperative imaging technique.
Spinal cord compression due to prolapse of cervical intervertebral disc (herniation of nucleus pulposus)
Authors: O'Laoire Sean A. , Thomas David G. T.
Published: May 2009

✓ Twenty-six patients who presented with spinal cord compression due to cervical disc prolapse (herniation of the nucleus pulposus) were treated by anterior discectomy. There was a high incidence of disc prolapse at the C3–4 level. The most severe degrees of preoperative disability were associated with prolapse at that level. Impairment of posterior column function, particularly in the upper limbs, played a major part in producing disability. High cervical disc prolapse can produce a clinical picture that is predominantly like that of a posterior cord syndrome. Preexisting fusion of vertebral bodies in the cervical spine and a history of cervical spinal trauma appear to be predisposing factors. Discectomy is an effective treatment of this condition. Spinal cord compression due to cervical disc prolapse should be distinguished from spondylotic myelopathy.
Congenital neural abnormalities presenting with mirror movements in a patient with Klippel-Feil syndrome
Authors: Whittle Ian R. , Besser Michael
Published: May 2009

✓ A young girl with Klippel-Feil syndrome presented with the onset of mirror movements in early childhood. Computerized tomography studies of her cervical spine and brain revealed fibrous diastematomyelia with duplication of the cervical spinal cord and an extra-axial midline posterior fossa cyst, together with the multiple cervical vertebral anomalies. Exploration of the posterior fossa lesion revealed it to be a dermoid cyst. The congenital spinal and cord abnormalities found in this case support the hypothesis that the Klippel-Feil syndrome may be associated with variable duplication of the spinal cord and that mirror movements may be related to impairment of pyramidal tract decussation.
A variant of normal-pressure hydrocephalus simulating Pick's disease on computerized tomography
Authors: Salibi Naman A. , Lourie Gerald L. , Lourie Herbert
Published: May 2009

✓ The authors present two cases of normal-pressure hydrocephalus that simulated Pick's disease radiographically and that were initially diagnosed as cortical atrophy. In both cases, Sylvian cisternoperitoneal shunts improved the clinical picture only temporarily, but ventriculoperitoneal shunting produced dramatic relief of all symptoms.
Prevention of chronic experimental cerebral vasospasm with ibuprofen and high-dose methylprednisolone
Authors: Chyatte Douglas , Rusch Nancy , Sundt Thoralf M.
Published: May 2009

✓ Severe chronic cerebral vasospasm was reliably induced in dogs by two injections, 2 days apart, of autologous blood into the cisterna magna. Treatment with ibuprofen or high-dose methylprednisolone after the first injection prevented or reduced vasospasm. Both drugs reduced meningismus and accelerated the rate of neurological recovery. Compared with specimens from normal dogs, rings of basilar arteries obtained from untreated dogs contracted weakly in response to 5-hydroxytryptamine, prostaglandin F2α, potassium chloride, and barium chloride. Rings of arteries from dogs who received ibuprofen or methylprednisolone contracted more strongly. Electron micrographs of basilar arteries from untreated dogs showed degeneration of smooth muscle, whereas those from treated dogs did not. Thus, what is termed “chronic cerebral vasospasm” probably represents a structural derangement of the blood vessel wall leading to its narrowing, rather than a sustained contraction of the vascular smooth muscle. Administration of high-dose methylprednisolone and ibuprofen can prevent its occurrence.
Nonsurgical management of extradural hematomas in children
Authors: Pang Dachling , Horton Joseph A. , Herron John M. , Wilberger James E. , Vries John K.
Published: May 2009

✓ With the advent of computerized tomography (CT), an increasing number of patients with only minimal neurological symptoms and no signs of brain herniation are found to harbor subacute or chronic extradural hematomas (EH's). The authors present the cases of 11 symptomatic but neurologically normal children with medium to large EH's managed by close observation. These EH's were discovered 4 hours to 6 days after injury; three were in the posterior fossa, seven over the frontoparietal convexity, and one in the temporal fossa. These clots were followed by serial CT scans. Nine children recovered without surgery from 4 to 18 days after injury, and all had evidence on CT of spontaneous clot resorption. Of these nine EH's, five clots displayed volume expansion from 5 to 16 days after injury before final resorption occurred. Expansion correlated with persistence or increase in symptoms, whereas resorption correlated with improvement. Two patients showed gradual uncal herniation on Days 6 and 8, respectively, presumably during the “expansile phase” of their clots. Both had emergency craniotomy and recovered without morbidity. It is hypothesized that the resorption dynamics of the subacute or chronic EH are similar to that of the chronic subdural hematoma, with predictable volume changes, and the outcome of each lesion depends on the interplay between the patient's intracranial pressure buffering capacity and the rate of volume change. If subtle signs of brain dysfunction are adopted to signal the failure of conservative treatment and the need for craniotomy, these patients may be safely, and many successfully, managed without surgery. Factors that influence outcome of medical treatment include the size, location, configuration, and the rapidity of accumulation of the clot, the presence of associated intradural lesions, the extracranial decompression of blood through skull diastases, and the age of the patient. These factors, the criteria for patient selection, and the indications for immediate operative intervention are discussed.
Clinical stages of human brain abscesses on serial CT scans after contrast infusion
Authors: Britt Richard H. , Enzmann Dieter R.
Published: May 2009

✓ The authors describe a classification of human brain abscesses into stages of development as demonstrated on computerized tomography (CT) scans. The results of CT staging of 14 human brain abscesses are compared with the previously published findings in an experimental brain abscess model developed by the same authors. The CT criteria for categorizing brain abscesses into cerebritis and capsule stages were based on the pattern of contrast enhancement and the time-density curve of enhancement obtained from sequential CT scans after contrast infusion. Using these CT criteria, it was possible to accurately categorize all 14 brain abscesses into cerebritis and capsule stages. Histological examination of surgical and autopsy specimens provided immediate confirmation of the abscess stage in six patients. Indirect staging, based on surgical findings and/or subsequent autopsy findings, was possible in eight patients. Corticosteroid administration greatly reduced contrast enhancement in the cerebritis stage, but had little effect in the capsule stage. A systematic approach utilizing CT for establishing the diagnosis, staging, and treatment planning of brain abscess is proposed.
Late results of treatment of intervertebral disc disease with chymopapain
Authors: Parkinson Dwight
Published: May 2009

✓ The authors report a 12-year follow-up review of 33 patients treated with chymopapain (Discase) injection for intervertebral disc disease. This carefully controlled series of patients was treated under local anesthesia in the prone position. Only the single offending disc that correlated with the myelographic and clinical pathology (without the use of discography) was injected with Discase. Anaphylaxis is treated instantly at the first sign of disturbance, and no patients suffered shock. The percentage of patients who were completely cured or improved continues at about 70%. Aside from sensitivity, complications attributable to proper use of the enzyme remain at zero. Follow-up review of those patients over 10 years would indicate that there is no risk of delayed organ toxicity, no risk of carcinogenesis, and no apparent risk of first-generation teratogenesis.
The use of stereotaxic chemical hypophysectomy in the treatment of thalamic pain syndrome
Authors: Levin Allan B. , Ramirez Lincoln F. , Katz Jordan
Published: May 2009

✓ Three patients with neurological injuries consistent with cerebral stroke subsequently developed pain over portions of the body contralateral to the injured hemisphere. Stereotaxic chemical hypophysectomy was used in the management of this pain after other surgical procedures and medical management had failed to provide relief. Postoperatively, all patients were treated for hypopituitarism. All developed transient diabetes insipidus, and one patient developed transient right third nerve palsy. No other complications were encountered. All three patients experienced significant pain relief within 48 hours of the procedure. By the date of discharge, two of the three patients reported complete, and the third greater than 80% pain relief. At the initial follow-up visit all patients were essentially pain-free. These patients have now been followed for 58, 39 and 19 months, and remain free of their original pain. During this time the intravenous administration of naloxone has failed to reproduce the preoperative pain. Pituitary function testing 1 year or more following operation demonstrated that none of the patients had an endocrinologically complete hypophysectomy. Recovery from transient diabetes insipidus was not associated with return of the original pain. The mechanism of action of stereotaxic chemical hypophysectomy in the relief of pain related to thalamic lesions remains unknown. The observation that naloxone failed to reproduce the preoperative pain casts doubt on the theory that augmentation of endogenous opiate release is the primary mechanism. Additional observations suggest that pain relief after hypophysectomy may be more directly the result of stimulation of a hypothalamic pain-suppressing mechanism than due to the elimination of pituitary hormones.
Percutaneous microcompression of the trigeminal ganglion for trigeminal neuralgia
Authors: Mullan Sean , Lichtor Terry
Published: May 2009

✓ Fifty patients were treated for trigeminal neuralgia by percutaneous microcompression of the trigeminal ganglion. A No. 4 Fogarty balloon catheter was inserted under brief general anesthesia, using biplane fluoroscopy. This procedure is essentially a percutaneous simplication of the older Taarnhøj-Sheldon-Pudenz operation. The follow-up period ranged from 0.5 to 4.5 years. Pain recurred in 12% of cases during that time, and it is anticipated that within 5 years the recurrence rate will reach 20%, which is approximately the same rate as for the alternative established procedures. The advantages of this technique are freedom from discomfort on the part of the patient, a remarkable ease of performance on the part of the operator, absence of associated mortality, and a minimal morbidity rate.
Auditory evoked potentials recorded from the cochlear nucleus and its vicinity in man
Authors: Møller Aage R. , Jannetta Peter J.
Published: May 2009

✓ Intracranial responses from the auditory nerve and the cochlear nucleus were recorded from patients undergoing neurosurgical operations during which these structures were exposed. Responses to stimulation of the ipsilateral ear with short tonebursts from the vicinity of the cochlear nucleus show a large surface-negative peak, the latency of which is close to that of peak III in the auditory brain-stem evoked potentials recorded from scalp electrodes. There was also a response to contralateral stimulation, smaller in amplitude and with a longer latency. It is concluded that the cochlear nucleus is the main generator of peak III responses, and that structures of the ascending auditory pathway that are more central than the cochlear nucleus are unlikely to contribute to wave III of the auditory brain-stem evoked potentials.
Orbital fine-needle aspiration biopsy in patients with cavernous sinus syndrome
Authors: Slamovits Thomas L. , Cahill Kenneth V. , Sibony Patrick A. , Dekker Andrew , Johnson Bruce L.
Published: May 2009

✓ The authors report their experience with five patients presenting with cavernous sinus syndrome who, on computerized tomography (CT) studies, were shown to have a lesion simultaneously involving the cavernous sinus and a portion of the orbit. All patients underwent an orbital fine-needle aspiration biopsy (FNAB). A specific cytological diagnosis was made in three of the five patients. To obtain pathological diagnosis in the case of cavernous sinus tumors, invasive diagnostic procedures are sometimes necessary. Extension of lesions from the cavernous sinus into adjacent areas should be carefully looked for on CT scans. In the specific subset of patients with cavernous sinus tumors and simultaneous orbital involvement, orbital FNAB may provide a simple alternative to more invasive procedures. The limitations of the procedure are discussed.
Transsphenoidal surgery of intrasellar germinomas
Authors: Baskin David S. , Wilson Charles B.
Published: May 2009

✓ Two patients with diabetes insipidus, hypopituitarism, and an enlarged sella turcica underwent a transsphenoidal operation for the treatment of intrasellar germinomas. Successful transsphenoidal treatment of such neoplasms has not been reported previously. The cases indicate that the diagnostic possibility of intrasellar germinoma should be considered in young patients with combined diabetes insipidus and hypopituitarism, even when the sella is markedly expanded.
Foreign-body granuloma simulating recurrence of falx meningioma
Authors: Shimosaka Shinichi , Waga Shiro
Published: May 2009

✓ The authors report a case of foreign-body granuloma that developed 1½ years after total removal of a falx meningioma. Prior to surgery, it was thought to be a recurrence of tumor.
Subependymoma in a 2½-year-old boy
Authors: Rea Gary L. , Akerson Robert D. , Rockswold Gaylan L. , Smith Stephen A.
Published: May 2009

✓ Subependymomas are extremely rare tumors in the pediatric population and, when they occur, they are usually of a mixed type with elements of subependymoma and ependymoma. This report is of a 2½-year-old male infant with a pure subependymoma of the fourth ventricle.
Arteriovenous malformations of the medial cerebral hemisphere and the limbic system
Authors: Stein Bennett M.
Published: May 2009

✓ In a series of 164 resected arteriovenous malformations (AVM's), 25 were located on the medial aspect of the cerebral hemispheres. These AVM's require special attention because of the following characteristics: 1) their obscure location, making resection more difficult than the usual AVM; 2) a high incidence of intraventricular hemorrhage; 3) their frequent involvement of the choroid plexus of the ventricles and the arteries and veins related to the choroid plexus; and 4) the configuration of their venous drainage, which is often to superficial veins as well as to the deep venous systems. The results achieved with excision of these difficult AVM's were good. There was no mortality and the morbidity rate was under 4%. The surgical exposures, which were tailored to the location of these malformations, are described in detail.
Vascular lesions due to transcranial stab wounds
Authors: Kieck Charles F. , de Villiers Jacques C.
Published: May 2009

✓ The cases of 109 patients with a transcranial or transorbital stab wound are presented. Angiography in 74 patients revealed 26 vascular lesions: 11 aneurysms, five carotid-cavernous fistulas, three other arteriovenous fistulas, three occlusions, two transections, and two instances of severe vascular spasm. The following important points and pitfalls are stressed: the 30% incidence of vascular lesions, the delayed onset of these lesions and neurological signs from 1 week to several months after trauma, and the incidence of delayed intracranial hemorrhage in four of 11 cases with traumatic aneurysms. The basal location of the lesions is described, and the authors warn against the misleading clinical picture of a trivial scalp wound in the absence of a “slot” fracture, with life-threatening neural and vascular damage on the opposite side. Aggressive investigation and treatment of these lesions are advocated because of the associated high morbidity and mortality rates, especially in patients with aneurysms.
Calcium pyrophosphate dihydrate deposits in the cervical ligamenta flava causing myeloradiculopathy
Authors: Nagashima Chikao , Takahama Motohide , Shibata Toshikatsu , Nakamura Hiroaki , Okada Keiichi , Morita Hitoshi , Kubo Hirokazu
Published: May 2009

✓ Three cases of cervical myeloradiculopathy associated with multiple calcified nodules containing identified calcium pyrophosphate dihydrate (CPPD) crystals in the ligamenta flava are described, with a comprehensive review of the 12 cases of this entity reported to date. The disease is characterized by: 1) oval or triangular areas of radiodensity in the posterior aspect of the cervical canal as seen in the lateral x-ray films and laminograms; 2) hemispherical areas of high density located almost symmetrically in the paramedial portion of the posterior spinal canal on computerized tomography scans; and 3) CPPD crystals in the nodules. It occurs independently or in association with cervical spondylosis or ossification of the posterior longitudinal ligament.
Success of microvascular decompression with and without prior surgical therapy for trigeminal neuralgia
Authors: Barba David , Alksne John F.
Published: May 2009

✓ Clinical records and patient interviews in 37 cases of trigeminal neuralgia treated by microvascular decompression by a single surgeon were studied retrospectively. Outcomes were determined with an average follow-up period of 43 months. Abnormalities in the region of the trigeminal nerve were identified in each case. Patients undergoing microvascular decompression as a primary procedure were cured (total pain relief without further therapy) at a rate of 91%, versus 43% in patients treated with destructive procedures (rhizotomies) prior to microvascular decompression (p < 0.005). Analysis also suggests that trigeminal neuralgia of greater than 9 years' duration was cured at a rate of only 42%, versus 88% in cases of less lengthy duration (p < 0.005). Sex and age at time of surgery were not significant predictors of outcome. There were no deaths in this group of patients aged from 32 to 90 years. A horizontal surgical approach is described.
Experimental sensory ganglionectomy by way of suicide axoplasmic transport
Authors: Yamamoto Teiji , Iwasaki Yuzo , Konno Hidehiko
Published: May 2009

✓ In attempts to destroy selectively the sensory ganglion cells via retrograde axoplasmic transport, either one or the other of the Ricinus communis agglutinins (RCA 60 and RCA 120), highly toxic lectins from castor beans, was topically applied to the proximal stump of the rat trigeminal branches (the mental and supraorbital nerves) or to the sciatic nerve. Within several days, the sensory ganglion cells associated with the nerve to which RCA was applied developed diffuse chromatolysis and subsequent dissolution of neuronal cell bodies. The resultant Wallerian degeneration of their primary afferent fibers could be traced within the brain stem and, in cases with RCA application to the sciatic nerve, within the spinal cord. This observation implies that the central counterpart of the peripheral nerve may be effectively destroyed by way of retrograde axoplasmic transport without direct attack on the target structure, and thus this method may be utilized in the future as a means for controlling various pain problems.
Assessment of Leeds device for monitoring intracranial pressure
Authors: Dearden N. Mark , McDowall D. Gordon , Gibson Robert M.
Published: May 2009

✓ In Leeds a screw device is used to monitor surface subarachnoid pressure following severe head injury. The possibility that such measurements may under-read true intracranial pressure (ICP) has led to the development of an infusion test to confirm free communication with the surface subarachnoid space. The results of 69 infusion tests using 18 devices reveal that the device was reading accurately on 33 of 69 occasions. In 31 of the remaining 36, correction of the problem was possible. Particularly at ICP values exceeding 20 mm Hg the Leeds device may under-read, and possible causes for this are discussed. Reliable readings can usually be obtained using the infusion sequence described.
Beneficial effects of induced hypertension on experimental stroke in awake monkeys
Authors: Hayashi Seiji , Nehls Daniel G. , Kieck Charles F. , Vielma Juan , DeGirolami Umberto , Crowell Robert M.
Published: May 2009

✓ The authors performed a controlled study of induced hypertension therapy for treatment of experimental stroke in unanesthetized monkeys. Ten control and 10 treated animals were subjected to a 4-hour occlusion of the middle cerebral artery (MCA) by an implanted tourniquet. Neurological status and local cerebral blood flow (CBF) were monitored serially. Local CBF was determined by hydrogen clearance in and around the elevated 20% to 40% by intravenous infusion of phenylephrine hydrochloride. Neuropathological evaluation was performed after about 2 weeks.

A 4-hour occlusion of the MCA in control animals caused moderate stable neurological deficits, moderate stable decreases in local CBF, and medium-sized infarcts. With induced hypertension, five of 10 treated animals showed neurological improvement, and eight exhibited increased CBF in the ischemic zone. Average infarct size tended to be smaller in the treated group, although the difference did not reach statistical significance. Hemorrhagic infarcts were not observed. In four animals, phenylephrine caused cardiac dysrhythmias and hypotension which were reversed by appropriate measures. In this unanesthetized primate model of moderate experimental stroke, induced hypertension had beneficial effects on neurological status, local CBF, and infarct size without causing hemorrhagic infarction. Induced hypertension may be beneficial for some clinical cases of focal cerebral ischemia.
Roentgen stereophotogrammetric analysis of neurocranial suturectomy in rabbits
Authors: Alberius Per , Selvik Göran , Ekelund Leif
Published: May 2009

✓ This investigation was conducted to further elucidate both the significance of a calvarial suture and the compensatory ability of the cranial vault. Four-week-old male New Zealand White rabbits were subjected to unilateral or bilateral extirpation of the coronal suture after insertion of metallic markers, and were then followed regularly by roentgen stereophotogrammetry until age 21 weeks. Bilateral extirpation of the normal coronal suture resulted in a dramatically increased initial rate of bone separation, which tended to remain supranormal for the rest of the investigation. Unilateral suturectomy showed differences in growth between the sides, the operated side initially separating significantly more than the other. Volumetric calvarial growth in rabbits with unilateral extirpation terminated similar to that in control animals, while volumes in rabbits with bilateral extirpations constantly exceeded control volumes, finally exceeding these by 65%. Responses at intact sutures confirmed the compensatory capacity of cranial vaults. The results indicate that the passive longitudinal and volumetric cranial vault bone growth responds quickly to growth disturbances, thereby demonstrating its plasticity, and that the neurocranial suture is a restraining and modulating component in cranial growth.
Roentgen stereophotogrammetric analysis of restricted periods of neurocranial suture immobilization in rabbits
Authors: Alberius Per , Selvik Göran
Published: May 2009

✓ The effect of temporary fusion of sutures on craniofacial growth was studied biometrically in 4-week-old male New Zealand White rabbits. Tantalum bone markers were implanted in the cranial vault, and the coronal suture immobilized with isobutyl-2-cyanoacrylate adhesive. Linear craniectomy was performed after 2 or 6 weeks of sutural growth restriction (four animals in each group). The animals were followed for approximately 17 weeks. Early craniectomy resulted in greatly increased coronal suture bone separation (175% of control growth rates in peers and 125% of maximal control rates). Growth after late craniectomy showed an age-dependent lower rate, but still the overshoot markedly surpassed controls (210% of control rates in peers and 65% of maximal control growth rates). Overall, both exhibited overcompensation in coronal suture growth. A rapid compensation of adjacent sutures to temporary growth restriction and a tendency toward spontaneous correction following release of growth inhibition were demonstrated. Thus, the total anteroposterior growth of the combined frontonasal and coronal sutures nearly equaled that of control animals. Following linear craniectomy, volumetric calvarial expansion increased considerably in both early and late groups, due to compensatory coronal suture growth, but probably due also to spatial bone rearrangements. Based upon the findings, the length of the suture immobilization period seems critical to longitudinal and volumetric growth as well as to subsequent compensatory activity after surgical correction.
Primary cerebral lymphoma: the “ghost tumor”
Authors: Vaquero Jesús , Martínez Roberto , Rossi Eduardo , López Rafael
Published: May 2009

✓ A case of primary cerebral lymphoma is presented. The particular biological features of these tumors may pose a special problem. In this case, the lesion was diagnosed on computerized tomography (CT) but was not found at surgery. The disappearance of the lesion was associated with a long period of corticosteroid therapy between CT diagnosis and the operation.
Cortical arteriovenous fistula associated with skull fracture
Authors: LaHaye Paul A. , Lawner Pablo M.
Published: May 2009

✓ The case is reported of a patient who presented with a skull fracture and delayed neurological deterioration due to a cortical arteriovenous fistula at the fracture site. The clinical course and surgical therapy are described. Theories as to the pathogenesis of this lesion as well as a discussion of other intracranial vascular injuries are presented.
Dural arteriovenous malformations of the spine
Authors: Symon Lindsay , Kuyama Hideyuki , Kendall Brian
Published: May 2009

✓ The clinical and angiographic findings of 55 patients with a spinal dural arteriovenous malformation (AVM) are reviewed, and the results of surgery assessed. The symptoms of dural AVM are usually gradual in onset, and hemorrhage from this type of AVM is less common than in true spinal cord angiomas. Other clinical features and the myelographic findings are similar to those of spinal cord angiomas. On angiography, the nidus of dural AVM's usually projected lateral to the spinal cord. Clipping of communicating vessels between the AVM and the coronal plexus was carried out in 50 patients, and decompressive laminectomy only in five cases. Surgery led to improvement of disturbed gait or arrest of a previously progressive course in 85% of those managed by clipping communicating vessels. The pathophysiology and surgical treatment of dural AVM's are discussed.
Comparative effects of barbiturate or enflurane anesthesia with induced hypotension on intrapulmonary shunting
Authors: Sokoll Martin D. , Gergis Samir D. , Kassell Neil F.
Published: May 2009

✓ Forty patients undergoing intracranial aneurysm clipping were operated on under either barbiturate anesthesia (in 22) or enflurane anesthesia (in 18). Cardiac output, arterial and mixed venous oxygen tension, and arterial, right atrial, pulmonary arterial, and pulmonary artery wedge pressures were measured. Cardiac index, intrapulmonary shunt fraction, and pulmonary vascular resistance were calculated. Hypotension to 60, 50, and 40 torr was induced with sodium nitroprusside. There was a decrease in shunt fraction with the induction of anesthesia in both groups. During induced hypotension there was a slight increase in shunting in the enflurane group. The venous oxygen content was significantly less than control values during the hypotensive period in both groups as a result of decreased cardiac output. The arteriovenous oxygen difference was significantly greater than control at the post-mannitol and hypotensive periods. Pulmonary vascular resistance was significantly less in the enflurane group.
Effects of halothane and fentanyl anesthesia on resistance to reabsorption of CSF
Authors: Artru Alan A.
Published: May 2009

✓ Using the technique of ventriculocisternal perfusion, resistance to reabsorption of cerebrospinal fluid (Ra) was examined in dogs during anesthesia with halothane (0.8%) or fentanyl (3.0 µg ⋅ kg−1 ⋅ min−1 for 20 minutes, followed by 0.2 µg ⋅ kg−1 ⋅ min−1, intravenously). Compared to normal Ra in dogs (220 to 224 cm H2O⋅ ml−1⋅min−1), halothane increased Ra to 245 ± 2 cm H2O⋅ml−1⋅min−1 (mean ± standard error of the mean), and fentanyl decreased Ra to 114 ± 1 cm H2O⋅ml−1⋅min−1. Changes in Ra caused by halothane or fentanyl may contribute, in part, to changes in intracranial pressure (ICP) observed during prolonged anesthesia with these agents. Because decreased Ra improves spatial compensation by cerebrospinal fluid volume during increased ICP, fentanyl may be preferred over halothane in patients at risk because of increased ICP.
Somatosensory evoked potential monitoring during the management of aneurysmal SAH
Authors: Wang Alexander D. , Cone Jeffrey , Symon Lindsay , Costa e Silva Izabel E.
Published: May 2009

✓ Somatosensory evoked responses to median nerve stimulation have been recorded during the management of subarachnoid hemorrhage from intracranial aneurysms. The type of measurement was central conduction time (CCT), the time interval between the N14 peak (at C-2) and the N20 peak (at the cortex). Significant differences were found between patients with aneurysms in clinical Grade 4 and normal individuals, although there was no significant difference between most aneurysm patients in Grades 1 through 3. The prolongation of CCT was found of prognostic value. Significant prolongation (mean plus two standard deviations) from the normal period of 5.4 ± 0.4 msec was found significantly useful to predict a less than satisfactory outcome (a patient with neurological signs or disabled) at 2 months, and these differences were detectable as early as 48 hours postoperatively. Differences between conduction time in the two hemispheres could also be used prognostically, although the significance of the differences did not appear until 48 to 72 hours after surgery, and was in any event less than that of CCT.
Transoral surgery for craniocervical space-occupying processes
Authors: Pásztor Emil , Vajda János , Piffkó Pál , Horváth Miklós , Gádor Ildikó
Published: May 2009

✓ Although the number of reports concerning the transoral approach to anteriorly placed lesions of the craniocervical junction are increasing, the development of this technique is still in its early stages. The indications and surgical methods vary widely, and there is much room for discussion of the technical details. Eight cases operated on via transoral surgery during the last 4 years are presented in support of the transoral approach to tumors in the craniocervical region.
Microvascular patch technique with and without Silastic T-tube bypass
Authors: Haines Peter C. , Donaghy R. M. Peardon
Published: May 2009

✓ Poor patency results in the surgery of small vessels operated on between 1959 to 1964 was demonstrated to be in part due to the long period of occlusion of the operated vessel during surgery and the presence of a foreign body (suture) in the lumen of the vessel postoperatively. New suture techniques and T-tube bypass were introduced at that time. New experimental data have not been extensively sought since that time. To provide further current data regarding the above observations, 110 arterial vessels (60 carotid arteries 1.1 to 1.3 mm in outside diameter (OD) and 50 femoral arteries 0.6 to 0.7 mm OD) were operated on in rats to compare the bypass versus non-bypass and vein patch closure techniques. In 1-mm vessels, patency rates 1 month after surgery were 100% regardless of the use of bypass or type of closure. Improved visualization, better suture material, and improved surgical skill were probably chiefly responsible for this success. The success rate was not as encouraging, however, in vessels of 0.6 mm OD.

The following points are brought out: 1) The presence of the bypass causes damage to the intima in 0.6 mm OD vessels and should not be used. Smaller bypasses do not conduct blood well. 2) Bypass is not required in 1-mm vessels as the patency rate is satisfactory and not altered by its use. 3) The major indication for T-tube bypass is in vessels of 1 mm OD and larger, that nourish tissue which would be damaged by vascular occlusion for 20 to 40 minutes. 4) Foreign body (suture) in the lumen is poorly tolerated in 0.6 mm vessels, but can be tolerated more easily in larger vessels. 5) Techniques that limit the amount of suture material in the lumen are indicated in 0.6-mm vessels. 6) After 1 month, suture material has an epithelial covering and if patency has been maintained for that period of time it is likely to remain.
Indications for surgical intervention in middle cerebral artery obstruction
Authors: Day Arthur L.
Published: May 2009

✓ The clinical, angiographic, and surgical characteristics of 31 patients with high-grade middle cerebral artery (MCA) stenosis or occlusion (jointly termed “MCA obstructions”) referred for cerebral revascularization by extracranial-intracranial (EC-IC) bypass are reviewed. Overall, 12 (66%) of the 18 patients with stenosis and all 13 (100%) of those with complete occlusion experienced clinically evident infarctions. Twenty-five of these patients underwent arteriography at least twice during their clinical course. Eleven (44%) demonstrated significant improvement in flow or complete resolution of obstruction on their second study. Ten of these 11 were patients in whom the initial arteriography was done within 2 weeks of symptom onset. Five other patients with stenosis exhibited obstruction that was worse on serial arteriography without surgical intervention.

The high incidence of resolution of MCA obstructions indicates that surgery should not be contemplated in most instances until delayed arteriography has been performed, at least 6 weeks after the onset of symptoms. Proximal embolic sources, such as the cervical carotid bifurcation, should receive carotid endarterectomy and repeat arteriography in appropriate patients prior to consideration of EC-IC bypass. Persistent high-grade MCA obstructions are thereafter potential candidates for EC-IC bypass, since leptomeningeal collateral vessels are marginal in their protective ability. Overall, of 15 patients who underwent an EC-IC bypass procedure, 14 were either stable or improved postoperatively, and 13 have been free of any further ischemic events without the use of major anticoagulant agents.
Subarachnoid hemorrhage from intracranial dissecting aneurysm
Authors: Friedman Allan H. , Drake Charles G.
Published: May 2009

✓ Rupture of an intracranial dissecting aneurysm is a rare but dangerous event. The authors' experience with 14 cases of these lesions on the vertebrobasilar circulation suggests that these aneurysms have typical angiographic silhouettes and that, at least in the vertebral artery, they are treatable by proximal arterial occlusion.
Does moyamoya disease cause subarachnoid hemorrhage?
Authors: Aoki Nobuhiko , Mizutani Hiroshi
Published: May 2009

✓ The majority of patients with intracranial hemorrhage associated with moyamoya disease have been described as having subarachnoid hemorrhage (SAH), but it seems doubtful that moyamoya disease causes primary SAH. Computerized tomography (CT) has revealed that most of the hemorrhage found in cases of moyamoya disease is intracerebral or intraventricular. The authors have reviewed 54 cases of intracranial hemorrhage confirmed by CT, including nine of their own, and found that in all but one the bleeding was intracerebral or intraventricular. The single case of SAH was due to rupture of a saccular aneurysm associated with moyamoya disease. It may be concluded from these results that moyamoya disease does not cause primary SAH per se.
Treatment of CSF shunt infections with intrashunt plus oral antibiotic therapy
Authors: Frame Peter T. , McLaurin Robert L.
Published: May 2009

✓ Infections of 12 cerebrospinal fluid (CSF) shunts in 11 children were treated with oral systemic antibiotic therapy plus daily intrashunt injections of antibiotics. Eight patients were infected with Staphylococcus epidermidis (four patients) or Staphylococcus aureus (four patients), and were treated with intrashunt vancomycin, plus oral trimethoprim/sulfamethoxazole (T/S), plus oral rifampin. One of these eight patients was later changed to a course of intrashunt cephapirin and oral cephalexin plus oral rifampin. One patient with Micrococcus varians infection was treated with oral T/S and rifampin, without intrashunt therapy, another patient with Pseudomonas cepacia infection was treated with intrashunt kanamycin plus oral T/S, and a third with Corynebacterium sp. infection was treated with intrashunt vancomycin plus oral T/S. Eight of the 11 patients required some form of shunt surgery, the most common being temporary externalization of the peritoneal end of the catheter. Only two shunts were completely replaced (both were ventriculojugular shunts which were changed to ventriculoperitoneal shunts). Nine of 10 evaluable cases were considered cured of their infections. The patient treated with cephalosporins had an uncorrected shunt malfunction and relapsed 1 month after completing therapy. The authors have shown that CSF shunts infected with Staphylococci can be effectively cleared with daily intrashunt vancomycin plus systemic therapy with oral T/S and rifampin. Less common infections may also be amenable to this form of therapy. Revision surgery, if necessary, should be carried out during the antibiotic therapy.
Prostate carcinoma presenting as intracranial hemorrhage
Authors: Barolat-Romana Giancarlo , Maiman Dennis , Dernbach Paul , Choi Hongyung
Published: May 2009

✓ The authors report a case of subdural metastasis from a prostatic carcinoma presenting as an acute intracranial subdural and intracerebral hemorrhage. The pertinent literature is reviewed.
Spinal cord compression by an osteochondroma in a patient with multiple osteochondromatosis
Authors: O'Connor Guy A. , Roberts Theodore S.
Published: May 2009

✓ The authors present the case of a 24-year-old woman with osteochondromatosis who experienced gradual onset of cervical myelopathy. Metrizamide myelography and metrizamide-enhanced computerized tomography revealed extensive extradural cervical spinal cord compression, and surgical removal of a lower cervical osteochondroma was performed. Although osteochondroma is the most common of the benign bone tumors, neurological involvement due to spinal cord compression is rare. Somatosensory evoked responses obtained before, during, and after surgery are also presented.