bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of severe hypoglycemia upon cerebrospinal fluid formation, ventricular iodide clearance, and brain electrolytes in rabbits
Authors: Carey Michael E. , Davson Hugh , Bradbury Michael W. B.
Published: May 2009

✓ Severe insulin-induced hypoglycemia in rabbits reduces cerebrospinal fluid (CSF) formation, but not ventricular iodide clearance as measured by ventriculocisternal perfusion. This indicates that CSF production is ultimately glucose-dependent but that ventricular iodide clearance is not. The data suggest that severe hypoglycemia results in intracellular potassium loss within the brain and show that extracellular sodium replaces lost intracellular potassium. Hypoglycemia probably results in cellular adenosine triphosphate (ATP) reduction which affects membrane Na/K ATPase and the ability of the brain cell to maintain a potassium gradient. Potassium levels in the CSF also rise consequent to hypoglycemia. Homeostatic mechanisms that maintain a constant CSF potassium, therefore, are also affected by hypoglycemia.
Suture pathology in craniosynostosis
Authors: Albright A. Leland , Byrd Ryland P.
Published: May 2009

✓ Gross and histological pathology of skull sutures affected by craniosynostosis was evaluated. Nineteen sutures were examined: 14 sagittal, three coronal, and two metopic. Sutures were removed en bloc, examined grossly, then sectioned perpendicular to the axis of the suture and examined microscopically. Foci of dural invagination into the sutures occurred in only four of the 19 specimens. In areas of maximum clinical abnormality, there was no microscopic evidence of the suture. The suture adjacent to the fused portion was narrowed by encroaching calvaria, and suture farther away was normal. Suture ossification was never multifocal. In infants less than 1 year old, the extent of suture fusion did not correlate with age. It is concluded that craniosynostosis is characterized by the progressive obliteration of cranial sutures by fusion of adjacent cranial bones, and that changes in the skull base angles are secondary to suture obliteration.
Complications of spinal drainage in the management of cerebrospinal fluid fistula
Authors: Graf Carl J. , Gross Cordell E. , Beck David W.
Published: May 2009

✓ Continuous cerebrospinal fluid (CSF) drainage may be used in the treatment of CSF fistula. The procedure, however, is not without risk. Marked gradients between the intracranial and intraspinal CSF pressures and intravasation of air through an unsealed fistula may produce serious neurological problems. The use of continuous CSF drainage requires an alert, informed nursing staff to avert catastrophe.
Value of immediate postoperative angiography following aneurysm surgery
Authors: Weir Bryce
Published: May 2009

✓ Two cases with technical failures of aneurysm clipping are reported in which immediate postoperative angiography permitted corrections to be made, with good outcome.
Spontaneous extracranial vertebral arteriovenous fistula with fibromuscular dysplasia
Authors: Reddy S. V. Ramana , Karnes William E. , Earnest Franklin , Sundt Thoralf M.
Published: May 2009

✓ A case of spontaneous vertebral arteriovenous fistula in association with fibromuscular dysplasia is reported. The patient presented with progressive cervical myelopathy and cervical bruit. The pathogenesis of the fistula development and the spinal cord symptoms is discussed. Symptoms subsided after obliteration of the fistula.
Combined cyclotron fast-neutron and BCNU therapy in a rat brain-tumor model
Authors: Spence Alexander M. , Geraci Joseph P.
Published: May 2009

✓ The combination of cyclotron fast-neutron radiotherapy with BCNU chemotherapy was compared to 137Cs gamma photon radiotherapy combined with BCNU in the 36B-10, F-344 rat-transplanted glioma model. Radiation and drug treatments were administered 7 to 8 days after intracerebral tumor implantation. Increase in animal survival time was used as the measure of the effectiveness of various treatment schedules.

Single-dose neutron or gamma radiotherapy was tested on Day 7 over the ranges 0 to 900 rads and 0 to 2000 rads, respectively. This therapy produced increases in mean survival times up to 70% at the highest radiation doses. When BCNU (10 mg/kg body weight) was administered intravenously on Day 8, 1 day following radiotherapy, mean survival times were increased by an additional 35% to 50%, irrespective of the dose or type of irradiation. In contrast, by using the same radiation and drug doses but scheduling combined therapy trials so that BCNU was administered 1 hour before either neutron or gamma irradiation on Day 7, there was enhancement of the radiation effect by BCNU. Under these conditions, the maximum enhancement of the mean survival time was 70% to 75% in neutron-treated animals and 120% to 150% in gamma-treated animals. Treatment with BCNU 1 hour before or 1 day after neutron irradiation proved to be no more effective in improving the survival time of tumor-bearing animals than the drug similarly combined with conventional gamma irradiation.
Results of early operations for ruptured aneurysms
Authors: Ljunggren Bengt , Brandt Lennart , Kågström Erik , Sundbärg Göran
Published: May 2009

✓ In a consecutive series of 219 patients with a ruptured aneurysm of the anterior part of the circle of Willis, 119 patients (54%) made a good recovery and 67 (31%) died. Of 53 patients who did not have surgery, six (11%) made a good recovery and 37 (70%) died. Urgent surgery with evacuation of an associated significant intracerebral hematoma was performed in 30 patients; nine (30%) made a good recovery and 15 (50%) died. Delayed surgery was performed in 55 patients of whom 42 (76%) made a good recovery and two (4%) died. Early intracranial operation (within 48 to 60 hours after subarachnoid hemorrhage (SAH)) was performed in 81 patients who were in Grades I to III prior to surgery. Sixty patients (74%) made a good recovery, and eight died within a month. Five patients were severely disabled and died 2 to 8 months after SAH and surgery. In 17 patients, although the immediate postoperative course was uneventful, evidence of cerebral ischemia developed 4 to 13 days after the bleed and resulted in death in eight patients. A poor outcome was correlated with a history of elevated blood pressure before SAH. Seven patients, of whom six were women of child-bearing age, demonstrated pronounced vasospasm on postoperative angiography; nevertheless, they remained well and free from ischemic symptoms after surgery.

Early operation combined with removal of subarachnoid clots and rinsing the basal cisterns does not eliminate the risk of delayed ischemic dysfunction. Such early surgery, however, improves overall outcome by preventing recurrent bleeding, and may also reduce the frequency of hydrocephalus.
Bacteriology of intracranial abscess in children
Authors: Brook Itzhak
Published: May 2009

✓ The bacteriological and clinical findings in 19 pediatric patients with intracranial abscess are presented. Ten children presented with subdural empyema and nine had brain abscess. Sinusitis was present in 14 children, and dental abscess in two. The abscess was located in the frontal and parietal area in seven instances each, and in the temporal area in five.

Anaerobic organisms alone were recovered in 12 (63%) of the patients (including eight with subdural empyema and four with brain abscess), aerobic bacteria alone were present in two children (11%), and mixed aerobic and anaerobic bacteria were present in five (26%) patients. There were 43 anaerobic isolates (2.3 per specimen). The predominant anaerobes were anaerobic Gram-positive cocci (16 isolates); Bacteroides sp. (10, including two B. fragilis); Fusobacterium sp. (nine isolates); and Actinomyces sp. (five isolates). A total of eight aerobic isolates (0.4 per specimen), including five Gram-positive cocci and three Haemophilus sp., were recovered. Antimicrobial therapy was administered to all patients. Five patients, four with sinusitis and subdural empyema and one with sinusitis and brain abscess, did not respond to antimicrobial therapy and aspiration of the abscess, and required surgical drainage of their inflamed sinuses. These findings indicate the major role of anaerobic organisms in the polymicrobial etiology of intracranial abscess in children.
Experimental study of fascicular nerve repair with and without epineurial closure
Authors: Kline David G. , Hudson Alan R. , Bratton Bert R.
Published: May 2009

✓ Microscopic fascicular repair without closure of epineurium was compared with microscopic epineurial repair in 12 rhesus monkeys. Measurements of evoked nerve action potentials, and responses to repetitive and tetanic stimulation made at one interval 3, 6, 9, or 12 months postoperatively, were compared to baseline preoperative studies. Histological evaluation included light and electron microscopic preparations and studies of distal stump myelinated fiber maturity. Electrical measures of regeneration indicated that recovery was more advanced in the limb with epineurial repair in eight animals, whereas in four there was no difference between fascicular and epineurial repair. Fascicular repair appeared not to fare as well as epineurial repair because, although neuromas developed with both, the length of the neuroma was greater with fascicular than with epineurial repair. The relatively lengthy neuroma in the nerve with fascicular repair was due to axonal disorganization and connective tissue proliferation along the length of the dissection necessary for the repair. Nonetheless, studies of myelinated fiber distribution in the distal stump showed no significant differences. Similar studies were conducted in 11 primates, where epineurial repair was matched with fascicular repair in which the epineurium was closed. Here, regeneration as measured by both electrical and histological studies was comparable. Histological study showed less disorganization at the repair site in the nerve with fascicular suture and epineurial closure than in that with epineurial suture. However, studies of distal stump myelinated fiber maturity demonstrated no significant differences. Thus, there seems to be no advantage in either resecting or closing epineurium in fascicular nerve repair.
SEM evaluation of the endothelial changes following end-to-side microvascular anastomoses in rats
Authors: Tomasello Francesco , Spadaro Antonio , Albanese Vincenzo , Conforti Paolo
Published: May 2009

✓ A scanning electron microscopic (SEM) study was carried out to evaluate the endothelial changes in carotid end-to-side microsurgical anastomoses. This procedure, associated with occlusion of the brachiocephalic trunk, was performed in 24 Sprague-Dawley rats. The animals were sacrificed at time intervals ranging between 15 minutes and 14 days after surgery. The specimens were collected after perfusion-fixation in vivo and treated for SEM observations. The findings show that the first 45 minutes are the most critical time for thrombus formation. Reendothelialization could be detected at 3 days after the microsurgical procedure. Endothelial regeneration occurred earlier on the suture line than on the stitches, documented by the migration and morphological changes of the endothelial cells advancing from the normal endothelium to cover the defect and the suture material. The repair was usually completed within 14 days. Damage of the inner vascular wall, related to minor failures of the microsurgical technique, appears to be a cause of delayed reendothelialization.
Successful clipping of carotid-ophthalmic aneurysms through a contralateral pterional approach
Authors: Nakao Satoshi , Kikuchi Haruhiko , Takahashi Nobuaki
Published: May 2009

✓ Two cases of carotid-ophthalmic aneurysm are reported in which the neck was successfully clipped by way of a contralateral pterional approach. The authors emphasize that in some cases this is the preferred approach; the aneurysm neck can be clipped without damage to important surrounding structures.
Extracranial aneurysm arising from the posterior inferior cerebellar artery
Authors: Hirschfeld Alan , Flamm Eugene S.
Published: May 2009

✓ A case is presented of an aneurysm arising from an extracranial loop of the right posterior inferior cerebellar artery (PICA). No similar case has been found in a review of the literature. The anatomy of the PICA is discussed, and the literature on aneurysms arising from this artery is summarized.
Posttraumatic pseudomeningomyelocele (enlarging fracture?) in a vertebral body
Authors: Sachdev Ved P. , Huang Yun P. , Shah Chunilal P. , Malis Leonard I.
Published: May 2009

✓ An unusual case is reported in which a posttraumatic pseudomeningomyelocele developed over many years inside the body of a fractured lumbar vertebra, eroding the pedicle and causing progressive neurological deficit. The wall of the sac was mostly formed by the scalloped bare bone, and partly by a membrane resembling the dura. The terminal part of the conus medullaris and some nerve roots of the cauda equina formed the contents and parts of the wall of the outpouching of the subarachnoid space into the vertebral body. A comparison is drawn between this lesion and formation of an “enlarging fracture” of the skull. The surgical technique used for obliteration of this pseudomeningomyelocele is described.
Embolization of segments of the circle of Willis and adjacent branches for management of certain inoperable cerebral arteriovenous malformations
Authors: Luessenhop Alfred J. , Mujica Patricio H.
Published: May 2009

✓ Most large cerebral arteriovenous malformations (AVM's) in the territories of the penetrating arteries arising from the circle of Willis, including the proximal anterior, middle, and posterior cerebral arteries, have been considered untreatable. However, the pattern of collateral circulation which accompanies these lesions presents the possibility of completely occluding certain segments of the circle of Willis and adjacent major branches without producing infarction distally in the cerebral hemisphere or in the critical areas occupied by the AVM itself. The ensuing reduction of arterial pressure within the AVM may reduce the likelihood of hemorrhage or progressive enlargement. Four patients in whom this was accomplished in whole or in part by embolization are described. In one patient, infarction did ensue but the potential for collateral circulation had been restricted by the passage of emboli into the pericallosal artery. In the others, angiographic filling of the lesion was considerably reduced without worsening of their neurological deficits. One patient had recovery of neurological loss following the procedure, and another was slightly improved. Over follow-up periods of up to 28 months there have been no recurrent hemorrhages or further progression of neurological deficits. However, final assessment of the efficacy of this procedure will require longer follow-up intervals and additional patients.
Late complications of carotid ligation in the treatment of intracranial aneurysms
Authors: Roski Richard A. , Spetzler Robert F. , Nulsen Frank E.
Published: May 2009

✓ The results in 57 consecutive patients treated with carotid ligation for an intracranial aneurysm were analyzed to define the risks of late complications. The average age for the group was 46 years. Eighty percent of the aneurysms were located on the internal carotid artery (ICA). The acute morbidity and mortality of the treatment and the natural history of the disease was 29%. Twenty-four patients were discharged with a common carotid artery (CCA) ligation, and 21 patients with an ICA ligation. Three patients from each ligation group could not be located for review. The follow-up period for the 21 patients with CCA ligation ranged from 1 to 15 years, with an average of 8.4 years, and for the 18 patients with ICA ligation it ranged from 2 to 19.5 years, with an average of 12.5 years.

Excluding deaths from unrelated causes, five of the 21 patients with CCA ligation developed a late complication. Two patients had a transient ischemic attack (TIA). Two patients had a subarachnoid hemorrhage (SAH), one of which was fatal and was preceded by a TIA. Two patients developed monocular blindness. None of the patients had a stroke. Excluding deaths from unrelated causes, five of the 18 patients with ICA ligation developed a late complication. One patient had a fatal SAH. Three patients had a TIA, two of which were followed by a stroke. One patient had a stroke in the cerebral hemisphere contralateral to the side of the carotid ligation.
Neurosurgical applications of ocular pneumoplethysmography
Authors: Bingham William F.
Published: May 2009

✓ Ocular pneumoplethysmography (OPG), a semiautomated form of suction ophthalmodynamometry, was used to evaluate and follow 15 patients who underwent carotid endarterectomy and two patients in whom gradual carotid artery occlusion was performed for inoperable intracranial aneurysm. Postoperative corrected ophthalmic arterial pressures (COAP's) on the operated side in the carotid endarterectomy patients averaged 12.5 mm Hg higher than before surgery, the standard deviation being 4.9 mm Hg for clinically stable patients. There was no significant change in COAP on the contralateral side. Several problems were encountered in closing down carotid clamps, the most potentially serious being a precipitous fall in COAP with the final adjustment. The current uses of OPG and similar techniques are reviewed, and potential neurosurgical applications are discussed.
Steroids in severe head injury
Authors: Saul Thomas G. , Ducker Thomas B. , Salcman Michael , Carro Eric
Published: May 2009

✓ This is a prospective randomized study of the efficacy of steroid therapy in patients with severe head injury. One hundred patients were randomized into two equal groups: the steroid group received 5 mg/kg/day of methylprednisolone, and the nonsteroid group received no drug. The groups were similar in their clinical features. All patients received a standardized therapeutic regimen. The patients were also classified as early responders or nonresponders to the overall treatment protocol without regard to steroid administration, on the basis of change in Glasgow Coma Scale score during the first 3 days of admission. There was no statistically significant difference in the outcome of the steroid and nonsteroid group at 6 months. Of the responders who were on steroids, 74% had good outcomes or were disabled, compared with 56% of the responders who did not receive steroids. In the nonresponder group, the patients on steroids were actually associated with a worse outcome than those who did not receive steroids: 75% of the nonresponders who received steroids were dead or vegetative, compared to 56% of those who were not receiving steroids. The data suggest that: 1) the effect of steroids may be different for different patient groups; 2) in order to identify these patients, a sensitive coma scale is needed; and 3) a rational approach to steroid therapy in head-injured patients may be to start all patients on steroids, but to discontinue their use in patients identified as not benefiting from steroid therapy.
Age as a critical factor in the success of surgical correction of craniosynostosis
Authors: Persing John , Babler William , Winn H. Richard , Jane John , Rodeheaver George
Published: May 2009

✓ The effect of timing of the surgical release of prematurely immobilized coronal sutures was studied in rabbits. At 9 days of age, the coronal suture was mechanically immobilized by the application of methyl cyanoacrylate adhesive. These animals and a control group then received metallic implants on each side of the suture to monitor growth. At 30, 60, or 90 days after suture immobilization, separate groups of animals underwent a linear suturectomy to release the restriction. In animals in which the suture was not released, growth at the coronal suture was significantly restricted and resulted in severe deformities in the neurocranium. The benefits derived from surgical release were time-dependent. Suturectomy at 30 days of age resulted within 60 days in achievement of 100% of the growth in sham-treated controls. In contrast, delayed surgery at 60 or 90 days of age resulted in achievement of only 38% and 17% of normal growth, respectively. Angular measurements of the vault and base of the cranium showed a similar graded response toward normality, with the greatest correction occurring with the earliest operation. These results support the clinical impression that early surgical correction of craniosynostosis results in superior cosmetic appearance. A further implication of this work is that abnormality at a single suture strongly influences the development of other areas in the craniofacial complex.
Oxidative metabolic activity of cerebral cortex after fluid-percussion head injury in the cat
Authors: Duckrow Robert B. , LaManna Joseph C. , Rosenthal Myron , Levasseur Joseph E. , Patterson John L.
Published: May 2009

✓ To assess the metabolic and vascular effects of head trauma, fluid-percussion pressure waves were transmitted to the brains of anesthetized, paralyzed, and artificially ventilated cats. Changes in the redox state of cytochrome a,a3, and relative local blood volume were measured in situ by dual-wavelength reflection spectrophotometry of the cortical surface viewed through an acrylic cranial window implanted within the closed skull. Initial fluid-percussion impacts of 0.5 to 2.8 atm peak pressure produced consistent transient oxidation of cytochrome a,a3, and increases of cortical blood volume. These changes occurred despite the presence of transient posttraumatic hypotension in some cases. Also, impact-induced alterations of vascular tone occurred, independent of the presence or absence of transient hypertension in the posttraumatic period. These data demonstrate that hypoxia does not play a role in the immediate posttraumatic period in cerebral cortex, and are consistent with the idea that after injury there is increased cortical energy conservation. These data also support the concept that head trauma alters the relationship of metabolism and cerebral circulation in the period immediately after injury.
Effects of anesthesia and laminectomy on regional spinal cord blood flow in conscious sheep
Authors: Hales J. Robert S. , Yeo John D. , Stabback Stefanie , Fawcett Alan A. , Kearns Raymond
Published: May 2009

✓ Blood flow for the whole spinal cord (SCBF), central cord (largely gray matter), and peripheral cord (largely white matter) has been measured at all segmental levels using radioactive microspheres in conscious sheep. Whole SCBF was greatest in the lower cervical and lumbar enlargements and least in the upper cervical and thoracic regions. This was attributable partly to regional variations in gray-matter blood flow but principally to regional variations in the proportion of gray and white matter present. Whole SCBF for the total cord was 14.5 ± 0.8 ml/100 gm/min, central cord flow was 40.6 ± 3.5 ml/100 gm/min, and peripheral cord flow was 9.7 ± 1.9 ml/100 gm/min. Blood flow was not affected by sodium pentobarbital provided the level of anesthesia, arterial pressure, and blood gases was carefully regulated. Laminectomy usually resulted in a marked increase in central cord blood flow at the site of cord exposure, lasting about 90 minutes; this increase was not necessarily reflected in whole SCBF because of the absence of any change in blood flow in the relatively large proportion of peripheral cord. This effect of laminectomy could adversely influence results obtained from studies using invasive techniques to measure SCBF.
Experimental neurogenic pulmonary edema
Authors: Hoff Julian T. , Nishimura Merry , Garcia-Uria Jose , Miranda Sandra
Published: May 2009

✓ Neurogenic pulmonary edema (NPE) was produced consistently in normal cats by increasing intracranial pressure with an intraventricular infusion of mock cerebrospinal fluid. The usual elevation of systemic arterial pressure (SAP) that follows severe intracranial hypertension (the “Cushing response”) was controlled by blood withdrawal at variable rates to achieve and maintain constant cerebral perfusion pressure (CPP) in three groups of cats of 50, 20, and 0 mm Hg, respectively, for 30 minutes. In this model, NPE occurs in the absence of increased SAP and in the presence of decreasing CPP. These results indicate that systemic arterial hypertension is not an essential stimulus for the development of NPE, and suggest that the lungs are directly affected by the intense sympathetic discharge evoked by severe intracranial hypertension.
Experimental neurogenic pulmonary edema
Authors: Garcia-Uria Jose , Hoff Julian T. , Miranda Sandra , Nishimura Merry
Published: May 2009

✓ Pressure changes in the aorta, left atrium, and main pulmonary artery were measured before, during, and after inducing increased intracranial pressure in cats. By selectively controlling each of the three pressures, it was concluded that pulmonary arterial hypertension is the single most important precursor of experimental neurogenic pulmonary edema. An earlier observation that neurogenic pulmonary edema may develop in the absence of systemic arterial hypertension was confirmed.
Presence of smooth-muscle cells in the subdural neomembrane
Authors: Kawano Nobuyuki , Suzuki Kinuko
Published: May 2009

✓ The authors encountered a case of chronic subdural hematoma of which the subdural neomembrane (SN) showed numerous spindle-shaped cells identified as smooth-muscle cells (SMC's) by electron microscopy. On reexamination of 214 cases from the files, SMC's were found with light microscopy in seven cases. In these cases, the SN was well organized (collagenized). In three additional cases examined with both light and electron microscopy, SMC's were not apparent with light microscopy. However, in all cases, cells with ultrastructural features of both fibroblasts and SMC's were observed. Well formed SMC's were found in two additional cases of well organized membrane. Based on these observations, it is concluded that the presence of SMC's in the SN is not a rare phenomenon. The possible origin of SMC's in the SN and their pathological significance to the organizing process of chronic subdural hematoma are discussed.
A new sequential pneumatic device for the prevention of deep vein thrombosis
Authors: Zelikovski Avigdor , Zucker Gidon , Eliashiv Avinoam , Reiss Raphael , Shalit Mordechai
Published: May 2009

✓ A new sequential pneumatic instrument for the prevention of deep vein thrombosis (DVT), the Lympha Press, was investigated in neurosurgical patients. In the control group, 50% of patients developed DVT and in the treated group only 4.3% were affected. These results demonstrate the highly beneficial effect of this method of preventing DVT during and after surgery, especially when the use of other preventive methods is precluded.
Percutaneous radiofrequency facial nerve coagulation in the management of facial spasm
Authors: Hori Tomokatsu , Fukushima Takanori , Terao Hideo , Takakura Kintomo , Sano Keiji
Published: May 2009

✓ The authors have developed a fluoroscopy-assisted technique of percutaneous radiofrequency facial nerve coagulation at or near the stylomastoid foramen for management of facial spasm. The details of the procedure and the operative results in the initial series of 27 cases of facial spasm are described. The series included six men and 21 women, aged from 16 to 73 years. Twenty-four patients had classical, intractable, persistent hemifacial spasm, one had an unusual bilateral facial spasm, and one a postparalytic facial spasm. The age of onset varied from 16 years to 70 years. The duration of the symptoms ranged from 3 months to 11 years. Ten patients had undergone previous blunt-needle compression of the facial nerve from one to 10 times. The operative results in the 27 patients have so far been excellent. The longest follow-up has been 1½ years. Although partial facial weakness was present in 60% of the cases, it invariably disappeared within 1 to 4 months. Only three patients experienced recurrence of spasm. In two of them, recurrence followed lowtemperature coagulation. The procedure is simple, easy to perform, and extremely effective. It can be performed under local anesthesia in the outpatient clinic.
Atypical carpal tunnel syndrome with compression of the ulnar and median nerves
Authors: Eskesen Vagn , Rosenørn Jarl , Osgaard Ole
Published: May 2009

✓ Clinical signs of ulnar nerve involvement at the wrist level were found in a 51-year-old man. The electrophysiological changes were indicative of a median nerve involvement in the carpal tunnel. At operation, the compressed ulnar nerve was found in the carpal tunnel, together with the median nerve. This localization of the ulnar nerve has not been described previously.
Multiple intracranial aneurysms associated with moyamoya disease
Authors: Nagamine Yoshihide , Takahashi Shinichiro , Sonobe Makoto
Published: May 2009

✓ A case of multiple intracranial aneurysms associated with unilateral moyamoya vessels is reported. The authors have reviewed the age, sex, initial symptoms, site of aneurysm, and operative indication in similar cases reported in the literature. It was found that aneurysms associated with moyamoya disease were frequently located in the vertebrobasilar system.
Basilar-middle meningeal artery anastomoses associated with a cerebral aneurysm
Authors: Katz Marcia , Wisoff Hugh S. , Zimmerman Robert D.
Published: May 2009

✓ Unique radiographic and autopsy findings are described in a patient with bilateral basilar artery-middle meningeal artery (BA-MMA) anastomoses associated with a ruptured aneurysm of the anterior communicating artery. The literature, anatomy, and embryology of BA-MMA anastomosis is reviewed.
Atypical fibromuscular hyperplasia
Authors: Wirth Fremont P. , Miller William A. , Russell A. Preston
Published: May 2009

✓ Two cases of atypical fibromuscular hyperplasia of the internal carotid artery (ICA) are reported. These cases are unique because the changes involve the intima of the vessels without involvement of medial structures as seen in the more common form of fibromuscular hyperplasia. Case 1 is only the fourth report of a symptomatic fibromuscular stenosis at the origin of the ICA. Case 2 is the first report of fibromuscular hyperplasia involving the common carotid artery. Changes similar to those in Case 2 (an elongated area of tubular fibromuscular stenosis) have been reported in the ICA. These atypical or intimal forms of fibromuscular hyperplasia appear to be more common in males and blacks, and may be more often unilateral as well.
Computerized tomography of contusional clefts in the white matter in infants
Authors: Ordia Idahosa J. , Strand Roy , Gilles Floyd , Welch Keasley
Published: May 2009

✓ A unique lesion of the infant's brain is the splitting in hemispheral white matter due to blunt trauma to the head. Two instances are described in which computerized tomography revealed the characteristic lesions. In one patient, one of two tears became less apparent with time.
Postoperative intracranial pressure in patients operated on for cerebral aneurysms following subarachnoid hemorrhage
Authors: Kaye Andrew H. , Brownbill David
Published: May 2009

✓ The postoperative intracranial pressure (ICP) in 36 patients operated on for cerebral aneurysm following subarachnoid hemorrhage was studied. Not only was the baseline ICP significantly lower in patients whose outcome was assessed as “good” as compared with those patients with a worse outcome at 1 month after surgery, but also the height of the plateau waves and B-waves was significantly less in the patients who did well. The baseline ICP and the height of the B-wave formation were unrelated to the position of the aneurysm. Plateau waves were marginally significantly higher in aneurysms of the anterior communicating artery complex. Neither preoperative hypertension nor the use of antifibrinolytic agents made any difference to postoperative ICP. In patients with cerebral arterial vasospasm found preoperatively on the angiograms, the ICP tended to be lower in the postoperative period than in those without spasm.
Cerebral vasospasm: presence of mast cells in human cerebral arteries after aneurysm rupture
Authors: Faleiro Luiz C. M. , Machado Conceição R. S. , Gripp Amado , Resende Rubens A. , Rodrigues Pedro A.
Published: May 2009

✓ Mast cells contain heparin, histamine, hydrolytic enzymes, and possibly serotonin in metachromatic cytoplasmic granules, and are not visualized in routine histological preparations. Special fixation, frozen sections, and toluidine blue staining are essential for counting the number of mast cells in tissue sections. Histological preparations for counting mast cells were made from arteries of the circle of Willis in persons who died after chest or abdominal trauma (control group) and in patients who had subarachnoid hemorrhage (SAH) after aneurysm rupture. The arteries were removed within 6 hours of death, taking care to avoid damage to their structure, and were immersed in the fixative solution.

This preliminary note, reporting findings in only a few cases, is justified by the interesting discovery of a marked increase in mast cell population in the muscular layer of arteries after SAH. The series is small because of the difficulty in obtaining suitable material, since mast cells virtually disappear when autopsy is performed later than 6 hours after death. It is concluded from this study that there is an increase of mast cell population in cerebral arterial walls after SAH, mainly in the muscular layer, and that the number of mast cells is higher in arteries closer to the aneurysm.
A modified slit-valve shunt prototype for the management of hydrocephalus
Authors: Di Rocco Concezio , Mancinelli Rino , Pola Pietro , Velardi Francesco
Published: May 2009

✓ The hydraulic properties of a double-slit valve for cerebrospinal fluid (CSF) shunting have been tested in vitro and compared to those of the corresponding standard single-slit valve. The double-valve system proved to compensate better for large transitory increases in CSF pressure than the single valves, without significant variations in the mean pressure levels.
Microgravimetric analysis of human brain tissue Correlation with computerized tomography scanning
Authors: Takagi Hiroshi , Shapiro Kenneth , Marmarou Anthony , Wisoff Hugh
Published: May 2009

✓ Microgravimetric technique was used to measure the water content of tumors and adjacent brain. Multiple 1-cu mm samples were obtained from 17 patients with neurosurgical lesions. The site of each sample was located on the appropriate computerized tomography (CT) slice, and the water content correlated with the CT attenuation coefficient.

The water content of peritumor white matter in 11 patients with glioblastomas was 5% to 8% H2O/gm tissue greater than the water content of white matter measured in three normal control individuals. These areas corresponded to low CT attenuation coefficients (8 to 15 EMI units). There were no statistically significant differences between the water content of tumors and adjacent white matter, even though the CT attenuation coefficient of the tumor was often of higher value. Low CT attenuation coefficient areas surrounding meningioma, metastasis, and lymphoma always correlated with elevated water content. The greatest water content (84.7% H2O/gm tissue) was found in the white matter surrounding an arteriovenous malformation. There was no correlation between the CT attenuation coefficient of this tissue and the water content in the arteriovenous malformation.

This study shows that areas of low CT attenuation coefficient may correlate with measurements of the water content of tissue, but that increased water content may exist without demonstrable changes in the CT attenuation coefficient.
Effect of trauma dose on spinal cord edema
Authors: Wagner Franklin C. , Stewart William B.
Published: May 2009

✓ The spinal cord of anesthetized cats was subjected to impact trauma of different intensities to determine how changes in trauma magnitude affect the formation and distribution of edema. All animals underwent a laminectomy to expose the cord segments corresponding to the T5–7 vertebrae. Fourteen cats were injected with fluorescein-labeled albumin, and then subjected to 260, 360, 500, or 700 gm-cm injury to the spinal cord. They were sacrificed at 8 hours after trauma. Twelve cats were injected with fluorescein-labeled dextrans of 20,000, 40,000, 70,000, or 150,000 molecular weight (MW) prior to 500 gm-cm injury, and sacrificed 8 hours after trauma. Serial cord sections from both groups were studied by fluorescence microscopy. In nine cats, sections of cord were removed 8 hours after trauma of 260, 360, or 500 gm-cm impact, and 1-cm sections were assayed for dry weight. Extravasated tracers were present in areas of hemorrhage at the site of impact in all animals. Extension of tracers and increases in tissue water rostrally and caudally from the site of impact were observed consistently with time only in animals receiving 500 or 700 gm-cm trauma. The distance of migration was similar for all tracers. The longitudinal distribution of increased tissue water was consistent with the distribution of fluorescent markers. The findings indicate that the longitudinal extension of posttraumatic edema is directly related to the amount of initial trauma.
Spontaneous cerebrospinal fluid rhinorrhea associated with dysplastic optic discs and a basal encephalocele
Authors: Bullard Dennis E. , Crockard H. Alan , McDonald W. Ian
Published: May 2009

✓ A 24-year-old man presented with a history of recurrent meningitis secondary to cerebrospinal fluid (CSF) rhinorrhea. The patient had bilateral optic disc dysplasia in association with a basal encephalocele, but had no midline facial anomalies. The syndrome is rare, and this is the first report of a patient with this disorder in the absence of facial or radiographic anomalies. The case serves to emphasize the importance of funduscopic examination in patients with spontaneous CSF rhinorrhea or recurrent meningitis, and stresses the value of Dextrostix examination of nasal secretions in the evaluation of suspected CSF rhinorrhea.
Subarachnoid hemorrhage secondary to an aneurysm of the ascending pharyngeal artery
Authors: Mujica Patricio H. , Rosemblat Aldo M. , Luessenhop Alfred J.
Published: May 2009

✓ The authors report a patient presenting with subarachnoid hemorrhage (SAH) secondary to one of two saccular aneurysms arising from the dural branches of the ascending pharyngeal artery. The aneurysms were obliterated by surgery without complications. Satisfactory visualization of the aneurysms required selective external carotid angiography with magnification and subtraction. This case emphasizes the need to include the external carotid system in conventional four-vessel angiography for evaluation of patients with SAH.
Pain control and improvement of peripheral blood flow following epidural spinal cord stimulation
Authors: Meglio Mario , Cioni Beatrice , Dal Lago Antonio , De Santis Mario , Pola Paolo , Serricchio Michele
Published: May 2009

✓ Chronic pain due to peripheral vascular insufficiency was relieved by epidural spinal cord stimulation (SCS) in an arteriosclerotic patient. Concomitant healing of trophic ulcers was observed. Hemodynamic studies showed an increase of peripheral blood flow following SCS. The therapeutic effect is still present after 14 months of stimulation.
Primary intracranial squamous cell carcinoma of the right cerebellopontine angle
Authors: Garcia Carlos A. , McGarry Paul A. , Rodriguez Fred
Published: May 2009

✓ A case of primary solid squamous cell carcinoma of the right cerebellopontine angle is described, and the literature is reviewed. Thirteen cases selected by strict criteria are analyzed, and the behavior of the lesion is described. This lesion seems to be found predominantly in middle-aged males in the cerebellopontine angle or parapontine region, and grows slowly.
Surgical management of holocord intramedullary spinal cord astrocytomas in children
Authors: Epstein Fred , Epstein Nancy
Published: May 2009

✓ This report describes the therapeutic approach to extensive multisegmental spinal cord astrocytomas in three pediatric patients. It is concluded that radical resection (gross total removal) is compatible with neurological recovery.
“Airgun retraction” for major bifurcation saccular aneurysms
Authors: Parkinson Dwight
Published: May 2009

✓ The author introduces a new use for the airgun: for blowing vessels or nerves free of the aneurysm sac in surgery of major bifurcation saccular aneurysms.
Induction of lethal experimental allergic encephalomyelitis in nonhuman primates and guinea pigs with human glioblastoma multiforme tissue
Authors: Bigner Darell D. , Pitts Olin M. , Wikstrand Carol J.
Published: May 2009

✓ The introduction of active specific immunotherapy as an adjunct to conventional therapy of the brain-tumor patient creates the risk of the concomitant induction of experimental allergic encephalomyelitis (EAE). The lack of resolution concerning the total group of central nervous system (CNS) antigens which may be encephalitogenic, and the lack of definition of the necessary conditions for the induction of an anti-CNS myelin response complicate the design of an immunotherapeutic regimen for brain-tumor patients. We report here the ready induction of EAE in four of four guinea pigs and both of two nonhuman primates (Macaca fascicularis) with human glioblastoma multiforme (GBM) tissue injected with either complete or incomplete Freund's adjuvant (CFA, IFA). Immunization protocols utilizing encephalitogenic GBM tissue and adjuvant which did not result in EAE induction were established in both of two macaques, and the production of significant levels of antibodies specifically reactive with immunizing GBM-derived cultured cell lines in all of 12 macaques without EAE induction was demonstrated. As the lower detection limit of the sodium dodecyl sulfate-polyacrylimide gel electrophoresis (SDS-PAGE) assay for human myelin basic protein (HBP) was 0.6 µg HBP/gel, and an extract prepared from WR-GBM tumor tissue contained less than 0.6 µg of detectable HBP/25 µg of pH 3 extractable protein, and as 100 to 1000 µg of purified human basic protein (HBP) failed to induce EAE in three of three macaques, it was hypothesized that 1) GBM tissue may act as an adjuvant and markedly lower myelin basic protein (MBP) threshold doses for EAE induction, that 2) MBP encephalitogenic fragments capable of EAE induction may be present in GBM tissue but difficult to quantitate in precipitates by in vitro methods, or that 3) secondary encephalitogenic antigens unrelated to MBP may be present in GBM tissue. The threat of EAE induction and the potential difficulty of its detection in the deteriorating brain-tumor patient receiving active specific immunotherapy warrants a biological screen in immunizing CNS material in experimental animals prior to administration to patients in immunotherapy protocols.
Unilateral germinomas involving the basal ganglia and thalamus
Authors: Kobayashi Tatsuya , Kageyama Naoki , Kida Yoshihisa , Yoshida Jun , Shibuya Naoki , Okamura Kazuhiko
Published: May 2009

✓ Clinical characteristics of six cases of germinoma involving a unilateral basal ganglion and thalamus are summarized. The incidence was estimated as 10% of all intracranial germinomas. The average age at the onset was 10.5 years. The sex incidence showed a male dominance. The clinical course was slowly progressive, and the average duration between onset and diagnosis was 2 years 5 months. Common symptoms and signs were hemiparesis in all cases, fever of unknown origin and eye symptoms in most, mental deterioration and psychiatric signs in three, and convulsions, pubertas praecox, and diabetes insipidus in two. Signs of increased intracranial pressure were found in only two cases in the later state of the disease. Early diagnosis is difficult because of nonspecific symptomatology and slow progression. Carotid angiography and pneumoencephalography showed abnormal findings compatible with basal ganglia and thalamic tumors, but not specific to germinoma. Ipsilateral cortical atrophy and ventricular dilatation might be significant findings. Radioisotope scanning was useful. Computerized tomography scans were the best method of detecting the location and nature of this tumor, and repeat scans showed response to radiation therapy.
Cerebral circulation after head injury
Authors: Overgaard Jørn , Mosdal Claus , Tweed William A.
Published: May 2009

✓ A series of comatose young patients with head injuries is presented in whom early regional cerebral blood flow (rCBF) is correlated with neurological outcome, and the critical threshold of rCBF compatible with recovery of responsive communicative interaction with the environment is estimated. Within the 1st week following injury, 63 patients had rCBF studies performed with radioactive xenon by the intracarotid bolus-injection technique and 35-channel external counting. A comparison was made between 2724 rCBF values from this group of patients with 381 from nine controls. Surviving patients were followed for 2 years to determine their eventual neurological outcome.

When histograms of the frequency distribution of rCBF values were examined, it was evident that there was both a wider spread of rCBF and a shift to the left in all outcome groups. In awake controls, no rCBF values were less than 40 ml/100 gm/min, whereas in comatose patients the threshold for recovery of communicative brain function (with or without neurological deficits) was between 17 and 20 ml/100 gm/min. There was a clear difference, however, between patients who recovered communicative brain function (with or without neurological deficit) and those who did not (dying or surviving in a persistent vegetative state). In the latter two outcome groups, 14.5% of rCBF values were less than 20 ml/100 gm/min, with the highest incidence in those examined within the first few hours of injury. The distribution of ischemic rCBF was mainly in the frontal and parietal lobes.

These investigations confirm previous postmortem pathological studies in revealing that cerebral ischemia in the frontoparietal “watershed” areas antemortem is a major factor leading to telencephalic brain death in the early hours after head injury. The pathophysiological mechanisms of this localized ischemia in patients with head injury are not well understood, but probably hemodynamic alterations resulting from increased intracranial pressure are a major factor. The critical threshold for survival of cortical function seems to be similar to that of normal brain, about 17 to 20 ml/100 gm/min.
Treatment of subdural empyema
Authors: Bannister Gordon , Williams Bernard , Smith Simon
Published: May 2009

✓ A review of 66 cases and a survey of the literature indicates that survival rates of around 90% should now be expected from patients with subdural empyema. Factors affecting the outcome are discussed. In addition to prompt surgical treatment and appropriate antibiotic therapy, the most important step seems to be extensive craniotomy and direct removal of subdural pus, particularly from the interhemispheric fissure. Treatment through burr holes is not acceptable. In the absence of a culture of the organisms and known antibiotic sensitivities, chloramphenicol is recommended as the drug of choice.