bluuebunny/crossref_metadata_2025 huggingface dataset:
Posterior-Lateral Foraminotomy as an Exclusive Operative Technique for Cervical Radiculopathy: A Review of 846 Consecutively Operated Cases
Authors: Henderson Charles M. , Hennessy Robert G. , Shuey Henry M. , Shackelford E. Grant
Published: May 2010

Between 1963 and 1980, one or more posterior-lateral foraminotomies were performed for simple cervical radiculopathy as the sole operative procedure for 736 patients. One hundred three patients (14%) required a second posterior procedure, but only 24 (3%) cases represented true recurrent radiculopathy. There were 13 minor complications (1.5%) and no deaths or detectable incidence of air embolism. All operations were done with the patient in the sitting position. Central venous pressure monitoring was used only infrequently. There was a 96% incidence of relief of significant arm pain and/or paresthesia and a 98% incidence of resolution of preoperatively present motor deficit. Eight hundred twenty-eight procedures (98%) were preceded by Pantopaque cervical myelography. There was a 71.5% incidence of correlation between preoperative clinical findings (both sensory and motor) and operative findings. In 13% of the cases, two spaces were thought by the operating surgeon to be equally involved by the spondylotic process. Most (91.5%) of the patients describe themselves as either “good or excellent” postoperatively. There was no significant difference postoperatively regarding results or recurrence between patients with suspected soft or hard disc protrusions and those with strictly spondylotic radiculopathy. Nor was there any statistical difference in results among the three patient population groups (“private” vs. compensation vs. liability). The mean length of time to return to work or other “normal” activities was 9.4 weeks. The mean length of follow-up time was 146 weeks (2.8 years). There was an associated incidence of significant lumbar disc and/or foraminal disease requiring operation of 33.4%.
Angiographic Demonstration of Postoperative Cortical Artery Stenosis Induced by Biemer Temporary Clips
Authors: Fein Jack M. , Dujovny Manuel , Kossovsky Nir
Published: May 2010

Five patients underwent cerebral revascularization operations during which Biemer clips were used to occlude temporarily a branch of the middle cerebral artery. Postoperative angiograms revealed stenoses at the sites where the clips were applied. Excessive clip closing forces may have caused significant endothelial injury, which then produced the stenoses. Clips that exert a minimal occlusive force would avoid this response and are recommended for temporary occlusion of cortical arteries.
Percutaneous Discectomy: An Alternative to Chemonucleolysis?
Authors: Friedman William A.
Published: May 2010

At the University of Florida, a new technique for lumbar disc removal, called percutaneous discectomy, has been explored. This procedure may be performed under general or local anesthesia, frequently takes less than 15 minutes, and is generally bloodless. The patient selection process and the surgical technique are presented in detail. A total of nine patients have undergone percutaneous discectomy. Seven had clear radiculopathies with appropriate radiographic findings, and they all have had excellent relief of symptoms. Two patients presented with intractable low back pain, bilateral mechanical findings, and central disc herniations on radiographic examination. One experienced good relief and one did not. Three patients had several days of paraspinous spasm after the procedure, and one complained of a lower extremity dysesthetic sensation that persisted for several weeks after operation. Our early experience with percutaneous discectomy suggests that it is a technically easy procedure that may prove, in carefully selected cases, to be a viable alternative to other discectomy techniques.
Use of an Anal Sphincter Pressure Monitor during Operations on the Sacral Spinal Cord and Nerve Roots
Authors: Pang Dachling , Casey Kenneth
Published: May 2010

The distinction of sacral roots and conus medullaris from lipoma, fibrous adhesions, and an abnormally thickened filum terminale can be difficult during operations on certain complicated dysraphic lesions. We describe a simple, noninvasive method of monitoring external anal sphincter “squeeze pressure” by means of an elongated, fluid-filled, polyethylene anal balloon connected to a pressure transducer. Cutaneous electrocardiographic (ECG) leads on both hips register the stimulus artifact from a monopolar nerve stimulator. The simultaneous display on the oscilloscope screen of the stimulus artifact and the resultant pressure response form an electromechanical coupling that allows the operator to identify a faulty stimulator probe and to distinguish true stimulus-induced external anal sphincter activity from spontaneous rhythmic contractions of the internal anal sphincter. Unilateral stimulation of the S-2, S-3, and S-4 roots generates tall pressure spikes between 40 and 75 torr in peak amplitudes, whereas S-1 and L-5 stimulation produces a stimulus artifact on the ECG but either no pressure response or a mere “ripple wave” of less than 7 torr. During operations on 11 patients with various dysraphic lesions, the S-2, S-3, and S-4 roots were identified easily and preserved, and the caudal extent of functioning neurons was localized within coni grossly distorted by intramedullary lipoma or chronic tethering. We prefer the anal sphincter pressure monitor to anal sphincter electromyography because of its simplicity, the inexpensive equipment, and its noise-free display that is virtually unaffected by other electronic systems in the operating room.
Primary Malignant Nerve Sheath Tumor of the Gasserian Ganglion: A Report of Two Cases
Authors: Levy W.J. , Ansbacher L. , Byer J. , Nutkiewicz A. , Fratkin J.
Published: May 2010

Primary tumors of the gasserian ganglion are usually benign, and secondary tumors are malignant. We report two cases of a malignant primary tumor of the gasserian ganglion, bringing the total in the world literature to five. The presentation, etiological features, and treatment of these cases are reviewed, together with a review of the literature. Preoperative differentiation from a benign tumor is not possible with certainty. A combination of operation and radiation therapy seems to be the best treatment at present.
Spinal Cord Arteriovenous Malformations Associated with Spinal Aneurysms
Authors: Miyamoto Susumu , Kikuchi Haruhiko , Karasawa Jun , Ikota Toshio , Nagata Izumi
Published: May 2010

Two patients with spinal cord arteriovenous malformations (AVMs) had coexisting spinal aneurysms on their main feeding arteries. The angiographic disappearance of these coexisting aneurysms after artificial embolization of the spinal cord AVMs suggests that hemodynamic stress is the important factor in the development of spinal aneurysms. The incidence of hemorrhage increases when spinal cord AVM is associated with spinal aneurysm.
Causes of Unfavorable Outcome after Early Aneurysm Operation
Authors: Ljunggren Bengt , Säveland Hans , Brandt Lennart
Published: May 2010

In a consecutive series of 160 patients in Hunt and Hess Neurological Grades I to III who were operated upon for a ruptured supratentorial aneurysm within 3 days after the hemorrhage, 42 patients (26%) had an unfavorable outcome. Delayed ischemic cerebral dysfunction with permanent deficit accounted for the unfavorable outcome in 18 patients (43% of all unfavorable results or 11% of the total series), whereas the unfavorable outcome was due to deficit ascribed to surgical trauma in 11 patients (26% of all unfavorable results or 7% of the total series) and to the initial hemorrhage in 7 patients (17% of all unfavorable results or 4% of the total series). Impaired outflow of cerebrospinal fluid with shunt dependency occurred in 3% of the total series. Of the patients with an unfavorable outcome, 17 (40%) had had arterial hypertension before the hemorrhage. The incidence of unfavorable outcome in good grade patients (Grades I and II) was not influenced by timing of operation (Day 1, 2, or 3 after hemorrhage). The results favor the opinion that it is principally the patient's condition during the acute stage that determines the outcome.
Factors in Predicting Outcome from Operation in Patients with Prolactin-secreting Pituitary Adenomas
Authors: Nelson Paul B. , Goodman Michael , Maroon Joseph C. , Martinez A. Julio , Moossy John , Robinson Alan G.
Published: May 2010

Forty female patients with pituitary adenomas were studied retrospectively to determine whether factors could be identified that would help predict outcome from operation. Twenty-five patients had a normal prolactin level (⩽30 ng/ml) during the early postoperative period (⩽3 months) and 15 patients had persistent disease (prolactin > 30 ng/ml). Nine of the 25 patients who initially had normal prolactin levels during the early postoperative period were found to have elevated prolactin levels during the late postoperative period (>3 months). As has been shown previously, tumor size and preoperative prolactin levels were important factors in predicting surgical outcome. Patients with smaller (Hardy Grades I and II) tumors had significantly better outcome than those with larger (Hardy Grades III and IV) tumors. Patients with successful surgical outcomes had significantly lower preoperative prolactin values (204 ng/ml) than those with operative failures (524 ng/ml). In addition to the known factors, the patient's age at the time of operation, the length of amenorrhea, and the patient's growth hormone response to insulin hypoglycemia were newly identified as factors that helped predict surgical outcome. Patients who were ⩽26 years of age and who had had amenorrhea for ⩽6 years at the time of operation had significantly better surgical outcomes. Patients with normal growth hormone responses to stimulation testing had significantly better surgical outcomes than those with a blunted preoperative growth hormone response. The data suggest that prolactin-secreting pituitary tumors may cause a progressive disorder for which operative cure may be obtained only early in the disease.
Spinal Hemangiomas
Authors: Healy Michael , Herz David A. , Pearl Lorraine
Published: May 2010

Three new cases of spinal cord compression due to vertebral hemangioma are reported. The clinical presentation, with spinal pain, radicular radiation, and paraparesis, is similar to that of primary lymphoma, metastatic tumor, and disc disease. If the characteristic plain film changes of vertical trabeculations and striations are present, the preoperative diagnosis is facilitated, but in the majority of cases these are not seen. In some instances, vertebral body or pedicle erosion is present. A myelographic epidural block will be seen on further study. Spinal arteriography can prove helpful. Surgical decompression results in marked neurological improvement if intervention takes place before the onset of complete paralysis. The authors recommend that the diagnosis of vertebral hemangioma be considered in the differential diagnosis of epidural spinal cord compression whenever a primary malignant neoplasm cannot be identified.
Dermoid Cyst Communicating with the Subarachnoid Space and Lateral Ventricle: Demonstration by Metrizamide Computed Tomographic Cisternography
Authors: Wakai Susumu , Narita Junichi , Hashimoto Kazumasa , Nagai Masakatsu
Published: May 2010

The authors report a case of a dermoid cyst in the right anterior cranial fossa, which communicated spontaneously with both the subarachnoid space and the lateral ventricle. The communication was demonstrated by metrizamide computed tomographic cisternography before operation and was verified during operation.
Dumbbell Ganglioneuroma of the Lumbar Spine Associated with a Herniated Intervertebral Disc: Case Report
Authors: Oro John James , Geise August William
Published: May 2010

Paraspinal ganglioneuromas with extension into the spinal extradural space are rare tumors. Their management usually requires cooperation with surgeons of other specialties. The authors describe a case of a dumbbell ganglioneuroma arising from the lumbar sympathetic ganglia in a patient presenting with a herniated lumbar disc. The clinical features, radiographic analysis, and surgical approach to these tumors are briefly discussed.
Cervical Myelopathy from Dural Substitute
Authors: Fisher Winfield S. , Six Eric G.
Published: May 2010

A case report of cervical spinal cord compression by infolding of a silicone-coated Dacron graft is presented. The possible complications of synthetic dural substitutes are discussed.
Two-Dimensional Echographic Localization of Intracardiac Cerebrospinal Fluid Shunt Catheters
Authors: Soyeur Daniel , Born Jacques , Lenelle Jacques , Stevenaert Achille
Published: May 2010

This study evaluated the ability of two-dimensional echocardiography (2D echo) to detect and localize the distal end of ventriculoatrial shunt catheters in the cardiac chambers of hydrocephalic patients. Twenty-eight patients were studied, and the performances of 2D echo and standard chest x-ray filming were compared. Although standard chest x-ray filming allowed accurate determination of the catheter position in only half of the patients, 2D echo afforded clear visualization and accurate localization of the catheter in all instances. By its precise definition of intracardiac anatomical landmarks and its excellent time determination, 2D echo can provide valuable information on the movements of the catheter's distal end during the cardiac cycle, during head flexion or rotation, and during deep breathing movements. Some interesting observations were made with 2D echo. A to-and-fro motion of the catheter tip through the tricuspid orifice during the cardiac cycle was visualized in two instances. The combination of head movements and deep respiratory movements induced a variation in the position of the catheter tip. The magnitude of this displacement was 6 cm at the most. Two patients underwent reoperation for lengthening or shortening of the catheter. The operative findings confirmed the ultrasonic localization in both cases where the chest x-ray film had failed to identify or adequately locate the catheter tip. It is concluded that 2D echo is a safe, innocuous, and accurate method with which to locate the distal end of a ventriculoatrial shunt. It is the only available technique that provides visualization of intracardiac structures and cardiac cycle reference. In our neurosurgical unit, 2D echo is now considered the standard reference procedure to localize postoperatively the distal end of ventriculoatrial shunts and to follow patients in an attempt to appreciate the ideal timing for prophylactic lengthening of the shunt.
Transthoracic Anterolateral Decompression for Thoracic Spinal Lesions
Authors: Lobosky Jeffrey M. , Hitchon Patrick W. , McDonnell Dennis E.
Published: May 2010

Since 1978, the authors have treated 11 patients with lesions of the ventral thoracic spine via a transpleural anterolateral approach. Each of the patients presented with pain and paraparesis, 8 had sensory dysfunction, and 6 had demonstrated sphincteric disturbances. All 11 had radiographic confirmation of anterior cord compromise, and each underwent an anterior decompression, with 8 requiring graft stabilization. There were no surgical mortalities, and the postoperative complications were limited. In follow-up, 10 of the 11 patients had complete resolution of their preoperative pain and were able to ambulate independently, Remission of sensory disturbances was noted in 6 patients, and 5 regained sphincteric control. The authors have found that this approach is both safe and effective, with several advantages over conventional laminectomy and posterolateral techniques.
Intracranial Neoplasms during the First Year of Life: Analysis of One Hundred Consecutive Cases
Authors: Jooma Rashid , Hayward Richard D. , Grant Norman D.
Published: May 2010

One hundred infants with intracranial tumors symptomatic during the 1st year of life were studied. They differed from older children in having a higher percentage of supratentorial tumors and in the fact that 90% of the tumors were of neuroectodermal origin. Vomiting, alteration of psychomotor development, and macrocrania were the most common presenting features. The “diencephalic syndrome” was seen in 5 infants, and subarachnoid hemorrhage due to tumor was diagnosed in 4. Computed tomography as the primary investigation is increasing the number of neoplasms diagnosed in this age group, although review of the skull roentgenograms in the series disclosed an abnormality in 92%. Eighty of the tumors were verified, 68 by a cranial operation and the rest at autopsy, Of the verified neoplasms, 20% were medulloblastomas, 12.5% were choroid plexus papillomas, and 10% were cerebellar astrocytomas. The cumulative average survival was 27 months but, for those who underwent a tumor operation, the average survival was 37 months. The operative mortality was 30%. Thirty-nine patients were irradiated, and this subset had a 5-year survival rate of 43%. The morbidity was high irrespective of radiotherapy; 60% of those who survived 1 year were moderately or severely disabled. Those infants receiving more than 5000 rads of whole brain radiation tended to have greater deficits in the long term. When analyzed separately, patients treated after 1970 had greatly improved mortality and morbidity rates.
Retractor for Lumbar Microdiscectomy: Technical Note
Authors: Bell William O. , Lavyne Michael H.
Published: May 2010

The authors describe a modification of an existing lumbar spine retractor for use in lumbar microdiscectomy.
Placement of a Ventriculoatrial Shunt Using External Jugular Catheterization: Technical Note
Authors: Tomita Tadanori
Published: May 2010

A technique for the insertion of the atrial end of a ventriculoatrial shunt is described. The technique utilizes a J-wire and an open end atrial catheter inserted through the external jugular vein into the right atrium under fluoroscopy. It is safe and effective, even in young infants.
Compressive Myelopathy Associated with Type VI Mucopolysaccharidosis (Maroteaux-Lamy Syndrome)
Authors: Wald Steven L. , Schmidek Henry H.
Published: May 2010

Spinal cord compression with resultant myelopathy is a frequent occurrence in patients with mucopolysaccharidoses. Etiological factors include developmental abnormalities of the cervical spine and infiltration of the dura mater by the accumulated products of mucopolyssacharide metabolism. Compression at the thoracolumbar junction is rare, but was found in a child with the characteristic physical and biochemical stigmata of the Maroteaux-Lamy syndrome (mucopolysaccharidosis VI). An anterolateral approach to remove the compressing bony elements resulted in symptomatic improvement. Careful radiological evaluation is required so that all surgical options can be considered. Patients with metabolic storage diseases and the capacity for normal intellectual function warrant aggressive surgical care to optimize neurological function.
Lateral Extracavitary Approach to the Spine for Thoracic Disc Herniation: Report of 23 Cases
Authors: Maiman Dennis J. , Larson Sanford J. , Luck Elizabeth , El-Ghatit A.
Published: May 2010

Twenty-three patients were operated upon for thoracic disc herniation between 1973 and 1982. The lateral approach to the vertebral column was used in each. Most patients had severe local pain; 13 had severe myelopathy or complete motor paralysis, including 4 who had become paraplegic after laminectomy. Eleven patients had calcified discs or osteophytic ridges. Air myelography and computed tomography were diagnostic in all cases. Postoperatively, 17 patients achieved significant relief of pain, 20 improved neurologically, and none became worse. Complications of the operation were minimal. The lateral extracavitary approach to the spine is a valuable technique for the management of thoracic disc herniation.
Epidural Hematoma Complicating Paget's Disease of the Skull: A Case Report
Authors: Drapkin Allan J.
Published: May 2010

A case of epidural hematoma associated with Paget's disease of the skull, following minimal head trauma, is presented. Review of the literature yielded only one previously reported case of this association. Factors of relevance in the development of epidural hematoma in patients with Paget's disease of the skull are discussed, and steps to consider in that situation are recommended. In view of the steady increase in the elderly population of this country, this association is likely to become more frequently seen.
Acute Traumatic Vertebral Arteriovenous Fistula: Balloon Occlusion with the Use of a Contralateral Approach
Authors: Miller Richard E. , Hieshima Grant B. , Giannotta Steven L. , Grinnell Verity S. , Mehringer Mark C. , Kerin Douglas S.
Published: May 2010

A traumatic fistula of the left vertebral artery to vertebral and epidural veins with an expanding suboccipital false aneurysm was trapped by endovascular occlusion with detachable balloons. The lesion was not amenable to treatment using the left vertebral artery alone for access. Distal trapping was accomplished by catheterizing the (contralateral) right vertebral artery and placing the balloon retrograde into the distal segment of the left vertebral artery. This maneuver extends the range of vertebral artery lesions for which detachable balloons, either alone or as an adjunct to operation, can be used.
Chronic Spinal Epidural Hematoma Presenting as Lumbar Stenosis: Clinical, Myelographic, and Computed Tomographic Features
Authors: Nehls Daniel G. , Shetter Andrew G. , Hodak John A. , Waggener John D.
Published: May 2010

The case of a patient with a chronic spinal epidural hematoma presenting as lumbar stenosis is described. There was no history of major trauma to the lumbar spine, anticoagulant use, or coagulopathy. The clinical, myelographic, and CT findings are presented and discussed.
Intracranial Primary Nonlymphomatous Sarcomas in Children: Experience with Eight Cases and Review of the Literature
Authors: Tomita Tadanori , Gonzalez-Crussi Frank
Published: May 2010

Eight infants and children with intracranial primary nonlymphomatous sarcoma were studied clinically and histologically. Treatment consisted of surgical resection and postoperative radiation therapy. Only one patient received chemotherapy. Two patients are alive after 10 years, but the other six patients died 3 to 33 months after operation. Two illustrative cases with neuroradiological, light microscopic, and ultrastructural findings are presented: both cases showed radiological evidence of intracranial arterial encasement by sarcoma and computed tomographic evidence of multifocal lesions. The pertinent literature is reviewed to illuminate the more refined nature of primary sarcomas of the central nervous system. Irrespective of treatment, the majority of the patients had a limited survival and only a few lived longer than 5 years. Total resection seemed to afford the best prognosis, whereas the efficacy of radiation therapy and chemotherapy is indefinite.
Posterior Fossa Epidural Hematoma during Childhood
Authors: Ammirati Mario , Tomita Tadanori
Published: May 2010

Four cases of childhood posttraumatic posterior fossa epidural hematoma diagnosed by computed tomography (CT) are reported. All four patients presented with relatively minor symptoms after sustaining head trauma and returned to normal after evacuation of the hematoma. The pertinent literature concerning posterior fossa epidural hematoma in children is reviewed. The role of CT in the early detection of lesions when the associated clinical symptoms are mild is emphasized.
Meningoencephalitis Complicated by Pituitary Insufficiency and a Spontaneously Resolving Suprasellar Mass
Authors: Jew Katherine , Piziak Veronica , Gilliland Paul F. , Hurley Douglas L.
Published: May 2010

A 53-year-old woman presented with acute meningoencephalitis associated with anterior and posterior pituitary insufficiency. A computed axial tomogram (CT) of the head revealed a suprasellar mass. The meningoencephalitis, presumably of bacterial origin, resolved after antibiotic therapy and, on a repeat CT, the suprasellar mass had disappeared. Five months after the initial illness, the patient's diabetes insipidus had resolved, anterior pituitary function had improved, and there was no sign of the suprasellar mass. The presence of a suprasellar mass in conjunction with acute meningoencephalitis and anterior and posterior pituitary insufficiency should raise the suspicion that the mass is not neoplastic and may be infectious or inflammatory in origin.
Intracerebral Arteriovenous Malformation Fed by the Anterior Ethmoidal Artery: Case Report
Authors: Terada Tomoaki , Kikuchi Haruhiko , Karasawa Jun , Nagata Izumi
Published: May 2010

The authors report a case of intracerebral arteriovenous malformation fed by the anterior ethmoidal artery. The nidus was located in the brain parenchyma, although its feeder was a dural artery. The etiology of this rare condition is discussed.
Microscopic Decompression of the Anterior Upper Cervical Spine: A Case of Odontoid Malunion to the Atlas
Authors: Miller Jimmy , Parent Andrew D.
Published: May 2010

For the past 20 years, the transoral approach to the upper cervical spine has been utilized for odontoid fractures, the removal of an abnormal odontoid process, decompression of basilar impression, and biopsy or resection of nasopharyngeal or metastatic tumors. The effectiveness and safety of this procedure is well documented. Use of the surgical microscope adds to the efficiency and safety of the procedure. We are reporting a case of fusion of the odontoid base to the anterior arch of the atlas. To our knowledge, this entity has not been described previously. The spinal cord was protected by an initial posterior fusion of C-1, C-2, followed in 10 days by a tracheostomy and the transoral removal of the anterior C-1 arch and the abnormal dens. Because the medical history did not reveal a source of trauma, it is supposed that the patient had malunion of the odontoid process to C-2, with subsequent migration and fusion of the dens to the C-1 arch.
Persistent Trigeminal Artery Associated with Intracranial Arterial Aneurysm
Authors: Garza-Mercado Román , Cavazos Elisamaría
Published: May 2010

Two patients with persistent trigeminal artery associated with a ruptured arterial intracranial aneurysm arising from the ipsilateral internal carotid artery at the level of the posterior communicating artery are presented. One patient underwent successful clipping of the aneurysm. The other patient died on the x-ray table shortly after admission during the performance of emergency carotid angiography. In each patient, the anomalous vessel was considered to be incidental.
The Sitting Position in Neurosurgery: A Retrospective Analysis of 488 Cases
Authors: Standefer Michael , Bay Janet W. , Trusso Russell
Published: May 2010

The records of 488 patients who underwent neurosurgical procedures in the sitting position were reviewed with special attention to the development of complications related to this operative position. The complications encountered included air embolus, pneumocephalus, subdural hematoma, compressive peripheral neuropathy, and orthopedic and dermatological problems. The 30-day operative mortality was 2.5%. These complications and methods of prevention, diagnosis, and treatment are discussed in detail, and the literature concerning the sitting position in neurosurgery is reviewed.
The Brain as a Sponge: A Computed Tomographic Look at Hakim's Hypothesis
Authors: Penn Richard D. , Bacus James W.
Published: May 2010

Hakim's hypothesis, which explains the brain's adaptation to pressure in hydrocephalus and the enlargement of ventricular volume, was studied with computed tomographic (CT) scanning. The critical element in the theory is that brain water decreases when there is a pressure gradient within brain tissue. Extraaxial hematomas uniformly increase the CT density of adjacent brain tissue, and this is best explained by water shifts out of the tissue. In hydrocephalus cases studied early after shunting (10 days or less), a decrease in ventricular volume is accompanied by an overall decrease in the CT density of the brain. These CT changes support Hakim's view of the brain as a sponge that can change its hydration under pathological conditions.
Evoked Potential Correlates of Posttraumatic Amnesia after Closed Head Injury
Authors: Papanicolaou Andrew C. , Levin Harvey S. , Eisenberg Howard M. , Moore Bartlett D. , Goethe Katherine E. , High Walter M.
Published: May 2010

The P-300 component of evoked potentials to a rare tone was measured in normal volunteers and in patients with closed head injuries who either were confused (in posttraumatic amnesia) or had recovered from posttraumatic amnesia and were oriented at the time of recording. The latency of this component, which reflects cortical processing of stimuli, varied reliably, with the degree of orientation being longest for confused patients and shortest for normal subjects. On the basis of these data, we suggest that the P-300 latency can be used as a physiological index of cognitive function in patients with closed head injury.
Intradural Rupture of Lumbar Intervertebral Disc: Report of Three Cases with Review of the Literature
Authors: Lesoin F. , Duquennoy B. , Rousseaux M. , Servato R. , Jomin M.
Published: May 2010

The intradural herniated disc is a rare complication of disc herniation. A study of the literature shows that this location is often responsible for severe neurological deficit with loss of sphincter control and a complete block shown on the myelogram. We report three cases to demonstrate the radioclinical interpretation of intradural herniated disc and the possibility of definite and misleading symptoms.
Contralateral Parafalcine Approach for Parasagittal and Callosal Arteriovenous Malformations
Authors: de Almeida Gilberto Machado , Shibata Milton Kazunori , Nakagawa Edson J.
Published: May 2010

Most neurosurgeons prefer an ipsilateral approach for medial surface arteriovenous malformations, Based on recent surgical experiences, we believe that a contralateral approach has some advantages in dealing with such lesions. Two cases are reported, and the rationale for the contralateral approach is discussed.
History of Frontal Lobotomy in the United States, 1935-1955
Authors: Anastasia Kucharski
Published: May 2010

The history of frontal lobotomy is a dramatic chapter in the development of medical treatment. Based on experimentally induced lesions in primates, lobotomies were introduced as procedures designed to modify the affect and behavior of hospitalized mental patients. Within 10 years, variations in surgical techniques were numerous, and the treatment was an accepted alternative in many hospitals in the United States. Patients on whom the operation was performed had a variety of diagnoses, including schizophrenia, obsessive-compulsive disorder, and affective illness. With the introduction of neuroleptic medication and behavior and milieu therapies, this surgical treatment for the emotional component of psychiatric illness fell into disuse. As its legacy to medicine, frontal lobotomy provided neuroanatomical information from which contemporary biological theories of behavior developed.
Cephaloceles: Treatment, Outcome, and Antenatal Diagnosis
Authors: Simpson Donald A. , David David J. , White Julian
Published: May 2010

A series of 74 cephaloceles (17 cranial meningoceles and 57 meningoencephaloceles) is reported. Infants born with large meningoencephaloceles containing recognizable cerebral tissue usually did badly despite endeavors to conserve brain function by expanding the cranial capacity (5 cases) or decompressing hydrocephalic ventricles (9 cases). Infants with cranial meningoceles almost all did well, even when there was associated hydrocephalus. The etiological diversity of cephaloceles is emphasized. Frontoethmoidal meningoencephaloceles, which occur with noteworthy frequency in South and Southeast Asia, require separate consideration in both genetic counseling and treatment; the associated facial deformities (hypertelorism and orbital dystopia) can be corrected with a one-stage craniofacial reconstruction. Antenatal diagnosis by ultrasound is now often possible and was achieved in 4 cases; we suggest that neurosurgeons should participate in such antenatal evaluations.
Evolution and Resolution of Intracranial Bacterial (Mycotic) Aneurysms
Authors: Morawetz Richard B. , Karp Robert B.
Published: May 2010

Surgical therapy of bacterial intracranial aneurysms may prove difficult when multiple aneurysms are present or lesions are proximally located. Two patients underwent operation for bacterial intracranial aneurysms without resolution of their problems, in one case because of the involvement of a proximal branch of a dominant middle cerebral artery and in the other because of the presence of multiple bilateral aneurysms. Both patients underwent multiple angiographic evaluations during the course of treatment with documentation of complete resolution of their aneurysms over many months. The time course of the evolution and resolution of the bacterial intracranial aneurysms identified in the two patients is described, and antibiotic therapy and cardiac surgery are discussed.
Cerebral Hyperperfusion after Carotid Endarterectomy: A Cause of Cerebral Hemorrhage
Authors: Bernstein Mark , Fleming Ross J. F. , Deck John H. N.
Published: May 2010

Correction of a very high grade carotid stenosis by endarterectomy in a normotensive man was followed by the development of severe unilateral head, eye, and face pain, seizures, and on the 6th day a fatal intracerebral hemorrhage. Autopsy revealed changes in the cerebral hemisphere ipsilateral to the endarterectomy that resembled the changes seen in malignant hypertension, whereas the opposite hemisphere was normal. These changes included hypercellularity and edema of arterial and arteriolar walls, with necrosis, extravasation of erythrocytes, and exudation of fibrin. We propose that the clinical and pathological features in this case were due to relative hyperperfusion of a cerebral hemisphere in which autoregulation had been impaired because of preoperative chronic hypoperfusion with chronic maximal dilatation of its blood vessels. This state of relative hyperperfusion is probably similar to the normal perfusion pressure breakthrough that occasionally occurs after the resection of cerebral arteriovenous malformations. It is similar to the breakthrough perfusion that occurs in severely hypertensive patients and results in hypertensive encephalopathy.
Ischemic Necrosis of the Scalp after Preoperative Embolization of Meningeal Tumors
Authors: Chan Richard C. , Thompson Gordon B.
Published: May 2010

The authors report two patients who suffered ischemic necrosis of their scalps after preoperative therapeutic embolic occlusion of the external carotid artery and its terminal branches for highly vascular meningeal tumors. Local anesthesia, selective catheterization of the external carotid artery, and radiopaque polyvinyl alcohol and Gelfoam as embolic agents were used. The various complications of external carotid artery embolization are reviewed. The importance of preserving normal branches of the external carotid artery (especially the superficial temporal artery) during embolization and of careful design of the scalp flap to avoid ischemic necrosis is emphasized.
Spontaneous Resolution of Chronic Epidural Hematomas: Report of Three Cases
Authors: Tochio Hiroshi , Waga Shiro , Tashiro Haruhiko , Takeuchi Toukichi , Miyazaki Masao
Published: May 2010

We report three cases of the spontaneous resolution of a traumatic chronic epidural hematoma. The patients were young adults with only mild headache after trauma. All patients were treated conservatively because of the very mild symptoms and the time lapse of 1 to 2 weeks between trauma and our unexpected detection of the frontal epidural hematomas. Slow, spontaneous resolution of the hematoma occurred in all three cases.
Trigeminal Schwannoma in a Child
Authors: Ross Diana L. , Tew John M. , Benton Corning , Eisentrout Craig
Published: May 2010

A 5-year-old girl presented with headache, vomiting, flushing, ptosis, and paroxysmal tachycardia. The neurological findings were partial motor and sensory left trigeminal palsy, left conductive hearing defect, and left cerebellar deficit. The radiological and neuropathological findings were typical for trigeminal schwannoma, which is rare in childhood. The present patient is the youngest yet recorded.
Choroid Plexus Papilloma of the Cerebellopontine Angle Presenting as a Subarachnoid Hemorrhage: Case Report
Authors: Piguet V. , de Tribolet N.
Published: May 2010

A case of a choroid plexus papilloma of the cerebellopontine angle that was revealed by a subarachnoid hemorrhage in a 5-year-old boy is presented, Subarachnoid hemorrhage and choroid plexus papilloma in children are discussed
Modified Crossed Leg Raising Test and Sciatica
Authors: Swann Karl W. , Zervas Nicholas T.
Published: May 2010

A modification of the crossed leg raising test has been helpful in identifying patients with intervertebral disc disorders. Simultaneous flexion of the neck and elevation of the contralateral leg produced pain in the ipsilateral (presenting) sciatic notch in five patients with either free fragments or herniated disc found at operation. All patients were symptomfree postoperatively.
Temporary Neurological Deterioration after Extracranial-Intracranial Bypass
Authors: Heros Roberto C. , Scott Michael R. , Kistler Philip J. , Ackerman Robert H. , Conner Scott E.
Published: May 2010

Five patients who experienced temporary neurological deterioration after extracranial to intracranial bypass procedures are reported in detail. These patients suffered transient ischemic attacks or more prolonged deficits usually of a different nature than the preoperative symptoms. All patients had a good outcome and the spells ceased; the neurological deficits improved within a maximum of 2 weeks. Obvious causes of deterioration such as intra- or extracerebral hematomas, occlusion of a previously stenotic vessel, or graft occlusion were ruled out by computed tomography and angiography in each case. Intraoperative causes of neurological deterioration such as anesthetic effect, hypotension, and temporary occlusion of the cortical vessel or sacrifice of its small branches were not likely to be the cause of the deficits because in each case. the patient awoke satisfactorily and deterioration occurred hours to days later. In each case, postoperative angiography showed good perfusion of at least one major division of the middle cerebral territory. Anticoagulation with heparin in three patients did not change the clinical course. In one patient who was not anticoagulated, embolism could have been responsible for a single prolonged ischemic event, but in the other patients thromboembolism does not seem likely to have been responsible for the deficits. The cause of the deterioration in these patients remains unexplained. We speculate that hyperperfusion of chronically ischemic brain tissue and shifts in the watershed region resulting from the new flow pattern after bypass grafting are two mechanisms that may have been of importance in the etiology of these deficits.
Ventriculoperitoneal Shunts in High Risk Newborns Weighing under 2000 Grams; A Clinical Report
Authors: James H. E. , James H. E. , Bejar R. , Gluck L. , Coen R. , Merritt A. , Mannino F. , Bromberger P. , Saunders B. , Schneider H.
Published: May 2010

Fifty-three low birth weight high risk newborns who developed progressive hydrocephalus despite a trial period of intermittent lumbar punctures underwent cribside ventriculoperitoneal shunt placement. They all weighed less than 2000 g at the time of shunting (mean, 1308.6 g ± 398.2 SD). The operative procedures were performed at a mean age of 31.5 days ± 16.1 (SD). There were no deaths in this series. During the nursery stay, 14 patients required operative revisions for obstruction. The most common problem was infection, which occurred in 13 (24.5%) after the primary intervention and in another 5 of the 14 (35.7%) patients who required revision. The overall infection rate/patient was 26.9%. Shunt removal and intensive antibiotic therapy cured the infection in all but 1 patient. Premature, low birth weight newborns may undergo ventriculoperitoneal shunting, but close follow-up for complications such as infection and shunt obstruction is always required.
Spontaneous Posterior Fossa Subdural Hematoma as a Complication of Anticoagulation
Authors: Kanter Roy , Kanter Merrill , Kirsch Wolff , Rosenberg Gary
Published: May 2010

We report a patient in whom a spontaneous subdural hematoma developed in the posterior fossa during anticoagulation therapy for mitral valve disease. This rare complication of anticoagulation has been reported in only three other patients.
Dural Arteriovenous Malformations and Intracranial Hemorrhage
Authors: Malik Ghaus M. , Pearce Jeffrey E. , Ausman James I. , Mehta Bharat
Published: May 2010

Intracranial hemorrhage is seen less frequently with dural than with intraparenchymal arteriovenous malformations (A V Ms). We report 6 cases of intracranial hemorrhage among our past 10 patients with dural A V Ms. A literature search provided 27 other cases of intracranial hemorrhage from a total of 213 reported dural A V Ms. Although hemorrhage was relatively infrequent (7.5%) with dural AVMs located primarily within a major venous sinus, bleeding episodes occurred in 20 of the 39 (51%) cases of malformation outside a major sinus. There was primary leptomeningeal venous drainage in all cases with hemorrhage, and a large variceal dilatation was seen in 14 cases (42%). Dural AVMs located outside a major sinus are uncommon, and they have a propensity for serious intracranial hemorrhage.
Radical Removal of Lipomas of the Conus and Cauda Equina with Laser Microneurosurgery
Authors: James Hector E. , Williams James , Brock William , Kaplan George W. , Hoi Sang U
Published: May 2010

Ten patients with ages ranging from 4 weeks to 21 years presented with a subcutaneous lumbosacral mass noted at birth. After spinal high resolution ultrasonography or computed tomography to determine the extent of neural involvement and the length of the tumor mass in the spinal canal, the patients underwent operation. Rectal electro-myographic continuous monitoring was used in all for assessment of the S-2 and S-3 function during dissection. Carbon Dioxide laser microneurosurgery was used in all operations. Radiating energy was used for the subcutaneous mass removal (40 to 60 W), the intracanalicular dissection (1 to 5 W), and the intraconus dissection (1 to 3 W). A radical removal was obtained in all. Postoperative cerebrospinal fluid fistula occurred in 1 patient and was successfully treated. Wound dehiscence that healed with secondary closure occurred in 2 patients. Wound infection that required treatment with systemic antibiotics and topical therapy occurred in 1 patient. Paraplegia occurred in 1 patient. This was the single very significant complication of this series. It was thought to have occurred because of the polymer used to seal the tenuous dura mater at the time of closure. We conclude that, with carbon dioxide laser microneurosurgery, the lipomatous tumors can be removed safely from the neural structures of the conus and cauda.
Role of Computed Tomography in the Management of Vasospasm after Subarachnoid Hemorrhage
Authors: Pasqualin Alberto , Rosta Luisa , Da Pian Renato , Cavazzani Paolo , Scienza Renato
Published: May 2010

The role of computed tomography (CT) in the management of vasospasm from subarachnoid hemorrhage was evaluated in 242 consecutive cases with CT performed within 7 days after hemorrhage. Only 20% of these cases did not show a detectable subarachnoid hemorrhage on CT. Subsequent angiograms showed vessel narrowing in 56% of the cases; associated clinical deterioration was noted in 34% of the cases. On later CT, clear ischemic areas were detected in 20% of the cases. A strict correlation between the amount of cisternal blood and the subsequent development of vasospasm was observed: although absent or thin cisternal depositions were rarely associated with vasospasm, consistent or thick depositions were frequently linked to vasospasm (72% of the cases) and to ischemic disturbances (51% of the cases), as well as to clear ischemic areas on later CT (30% of the cases). Regarding the morphology of the cisternal blood collection, the risk of developing vasospasm was at its lowest (42%) for depositions only in the frontal interhemispheric fissure and was at its highest (79%) for depositions in multiple cisterns. The site of cisternal deposition corresponded closely to the area of ischemia on later CT. The persistence of subarachnoid blood more than 72 hours after hemorrhage probably increases the risk of vasospasm, although our data are not conclusive. The definition of a CT scan “at risk” for vasospasm—based on the previous findings—gives practical advantages: proper selection of patients in regard to timing of operation, closer observation and the possibility of prophylactic treatment in patients “at risk,” and more adequate evaluation of different therapeutic modalities for vasospasm. With regard to the last point, the incidence of vasospasm was not statistically different between two groups of patients uniformly “at risk”: the first group submitted to early operation and the second awaiting operation.
Depression of Circulating Blood Volume in Patients after Subarachnoid Hemorrhage: Implications for the Management of Symptomatic Vasospasm
Authors: Solomon Robert A. , Post Kalmon D. , McMurtry James G.
Published: May 2010

The result of 42 blood volume determinations made with autologous red blood cells labeled with chromium-51 are reported. The subjects consisted of 11 control patients and 25 patients with recent subarachnoid hemorrhage (SAH). The mean red blood cell volume (RBCV) and the total blood volume (TBV) for female patients after SAH were significantly lower than corresponding control values (P < 0.01). No depression of blood volume was found in males as a group. Seventy-two per cent of females had below-normal RBCV and 50% had below-normal TBV. Fifteen patients demonstrated angiographic vasospasm or signs of cerebral ischemia. Only 1 patient with asymptomatic vasospasm had a below-normal RBCV or TBV, whereas 6 of 7 patients with symptomatic vasospasm had a subnormal RBCV or TBV. The mean RBCV and mean TBV for female patients with symptomatic vasospasm were significantly lower than corresponding control values (P < 0.02) and lower than values for female patients with asymptomatic vasospasm (P < 0.05). The data suggest that volume status may be the important differential between asymptomatic and symptomatic vasospasm. Delayed ischemic deficits can be expected to develop in patients who have both spasm of the intracranial vessels and decreased TBV. Patients with normal blood volume are far less likely to experience cerebral ischemia, even if vasospasm develops.
Osmotic Blood-Brain Barrier Modification and Combination Chemotherapy: Concurrent Tumor Regression in Areas of Barrier Opening and Progression in Brain Regions Distant to Barrier Opening
Authors: Neuwelt Edward A. , Hill Suellen A. , Frenkel Eugene P.
Published: May 2010

Chemotherapeutic drug delivery can be enhanced by administering drugs into the internal carotid or vertebral artery circulation after osmotic opening of the blood-brain barrier (BBB). As evidence of the clinical implications of this technique, radiographic documentation of central nervous system (CNS) tumor regression was observed in three patients concurrent with the development of new tumor nodule(s) in portions of the brain distant from the region of osmotic blood-brain barrier opening. These three patients, one with metastatic carcinoma of the breast, one with glioblastoma, and one with primary CNS lymphoma, highlight the importance of drug delivery to CNS malignancies.