bluuebunny/crossref_metadata_2025 huggingface dataset:
Vancomycin treatment of cerebrospinal fluid shunt infections
Authors: Visconti Ernest B. , Peter Georges
Published: May 2009

✓ The successful use of vancomycin is reported in two children with shunt infections due to Staphylococcus epidermidis which failed to respond to shunt removal. The previously reported experience with this drug is reviewed. The use of vancomycin should be considered in cases of shunt infections due to susceptible micro-organisms and refractory to other therapeutic measures.
Xanthogranuloma of the third ventricle
Authors: Szper Ivar , Oi Shizuo , Leestma Jan , Kim Kwan Soo , Wetzel Nicholas E.
Published: May 2009

✓ The case history of a patient with a xanthogranuloma of the third ventricle is presented. This type of lesion formed by desquamation of epithelium is usually noted as an incidental autopsy finding in the choroid plexus of the lateral ventricles. Total removal via a transcortical transventricular route led to complete recovery. These tumors should be suspected in the geriatric population. The computerized tomography findings and a review of the literature are included.
Supratentorial hemangioblastoma in a child
Authors: Tomasello Francesco , Albanese Vincenzo , Iannotti Fausto , Di Iorio Giuseppe
Published: May 2009

✓ Hemangioblastomas are rarely seen in the supratentorial region, especially in childhood. The case of a 10-year-old boy with left parieto-occipital cystic hemangioblastoma is reported. The neoplasm was not attached to the dura, nor was it associated with von Hippel-Lindau syndrome or with erythrocythemia. Cerebral angiography showed no evidence of a vascularized tumor, whereas computerized tomography gave more accurate information. The gross and microscopic appearance of the lesion is described, and a review of similar cases previously reported in the literature is presented.
Recurrent chemical meningitis due to an intraspinal cystic teratoma
Authors: Larbrisseau Albert , Renevey Francois , Brochu Pierre , Décarie Michel , Mathieu Jean-Pierre
Published: May 2009

✓ This is the first case report of an intraspinal cystic teratoma that manifested itself in recurrent episodes of chemical meningitis, with no sign of a space-occupying lesion.
Sublabial rhinoseptoplastic technique for transsphenoidal pituitary surgery by a hinged-septum method
Authors: Fukushima Takanori , Sano Keiji
Published: May 2009

✓ A new modification of the transseptal, transsphenoidal approach to the sella turcica is described. The procedure consists of unilateral dissection of the septal mucosa through a sublabial route, and retraction of the entire nasal septum with its upper attachment as a hinge. For mobilization of the septum, an L-shaped osteotomy is made along the base of the septum and along the anterior wall of the sphenoid sinus. It provides adequate exposure of the sphenoid sinus while preserving the septal structures. The anterior nasal spine and the edges of the nares are also left intact. The anterior wall of the sphenoid sinus is resected en bloc and is used as a bone splint for the reconstruction of the sellar floor. This approach has been performed in 45 cases of pituitary adenoma, one of craniopharyngioma, and one with sphenoid mucocele. There was no instance of complications such as mucosal perforation, septal deformity, or infection. Modifications of the surgical instruments used are described.
Surgical treatment of single brain metastasis
Authors: Galicich Joseph H. , Sundaresan Narayan , Thaler H. Tzvi
Published: May 2009

✓ From July, 1977, through December, 1978, a series of 33 patients with solitary brain metastases underwent surgical resection and postoperative radiation therapy at Memorial Sloan-Kettering Cancer Center. Sequential computerized tomography (CT) scanning was performed to determine the incidence of local recurrence and new brain metastases. The cause of death was identified by clinical follow-up study. The median survival for the entire group was 8 months, with a 1-year survival of 44%. Of the patients with no evidence of systemic cancer at the time of craniotomy, 81% lived 1 year. Local recurrence was noted in one patient known to have subtotal removal of tumor, and three patients developed carcinomatous meningitis. Of the 20 patients who died, four died within 30 days following surgery; three died of causes related to the central nervous system (CNS); and 13 (65%) succumbed to systemic cancer. These data show that recurrence in the CNS following surgery and radiation therapy for single brain metastasis is low, and that serial CT scanning provides a much better measure of the effectiveness of treatment of this complication of cancer than survival times. It is suggested that results of CT and neurological examination be used as indices when comparing different modes of therapy for brain metastases. Significant further improvement in survival of these patients is dependent on control of systemic cancer.
New frame for stereotaxic surgery
Authors: Gouda Kasim I. , Gibson R. Myles
Published: May 2009

✓ A new frame designed for stereotaxic surgery allows performance of a one-stage procedure without the need for mathematical calculation or the use of atlases or diagrams. This frame simulates the reference line in the center of the brain with two lines, one on each side of the head (on the frame) parallel and equal in length to the reference line and at equal distance from the midline. Lesions can be made easily and accurately on either or both sides in a one-stage procedure with use of precise data for the target through any specific or pre-existing burr hole.
Primary intracranial choriocarcinoma
Authors: Kawakami Yasuto , Yamada Osamu , Tabuchi Kazuo , Ohmoto Takashi , Nishimoto Akira
Published: May 2009

✓ The authors report four cases of primary intracranial choriocarcinoma, all in young males. Three tumors occurred in the pineal region and one in the lateral ventricle. Besides the signs of increased intracranial pressure and ophthalmological disorders, skin pigmentation or eruption was observed in three cases and precocious puberty in two cases. Angiography revealed tumor stain with irregular vessels in all cases. Enhanced computerized tomography scans in the last two cases demonstrated a round, lobulated lesion of high density, with relatively low density in the central portion. Hormonal study was carried out in three cases. In addition to high levels of human chorionic gonadotropin (HCG) in the urine and cerebrospinal fluid and/or of plasma luteinizing hormone (LH), LH in the tumor tissue or medium obtained via cell cultures was also high in all three cases, suggesting inherent activity of HCG secretion by the tumor cells. The tumors were relatively demarcated from the surrounding brain. They were very hemorrhagic, and fresh hematoma was identified in the tumor in one case. Good results were obtained in two cases treated with surgical removal followed by simultaneous chemotherapy and 60Co irradiation.
Long-term prognosis in surgically treated intracranial aneurysms
Authors: Artiola i Fortuny Lydia , Prieto-Valiente Luis
Published: May 2009

✓ A series of 265 consecutive cases of intracranial aneurysm were reviewed to assess mortality and its causes. Preoperative and postoperative factors were considered in isolation and in combination. The mortality rate was 20%. Postoperative generalized vasospasm was found to be the major cause of mortality. Advanced age, hypertension, and a poor neurological state at operation were associated with poor results. The study emphasizes the importance of considering variables in combination rather than singly in the assessment of prognosis.
Cerebrospinal fluid fistulas complicating missile wounds of the brain
Authors: Meirowsky Arnold M. , Caveness William F. , Dillon James D. , Rish Berkley L. , Mohr Jay P. , Kistler J. Philip , Weiss George H.
Published: May 2009

✓ The records of 101 casualties of the war in Vietnam have been analyzed, with particular attention to missile wounds of the brain complicated by a cerebrospinal fluid (CSF) fistula. Fifty-four developed CSF drainage at the wound site, 30 presented with rhinorrhea, and 23 with otorrhea. Fifty of the 101 men developed infection, an incidence of 49.5%.

The occurrence of a fistula in vertex wounds can usually be traced to failure to close the dura, or to achieve watertight closure of the dura primarily, or by graft. Approximately two-thirds of compound basilar fractures, complicated by rhinorrhea or otorrhea, are due to direct fractures of the anterior, middle, or posterior fossa. The remaining one-third are due to elusive “discrete” fractures of the base of the skull, occurring at a distance from the entry wound, and not in continuity with the fracture of the vault. While direct basilar fractures can readily be recognized, facilitating repair of the dura overlying the basilar fractures, “discontinuous” fractures pose a challenging diagnostic problem. More commonly occurring in vertex wounds crossing the midline, discontinuous fractures producing rhinorrhea or otorrhea may be identified with the aid of tomograms of the base of the skull. Their early diagnosis may well prove to be a significant factor in the reduction of morbidity and mortality of missile wounds of the brain complicated by a CSF fistula.
Gangliogliomas: pathological and clinical correlation
Authors: Johannsson Johann H. , Rekate Harold L. , Roessmann Uros
Published: May 2009

✓ Fourteen cases of ganglioglioma are analyzed. This tumor can be found anywhere within the central nervous system. The histological appearance is highly variable and does not relate to the biological behavior. The prognosis depends on the location and possible modes of treatment. Overall, the lesion appears to be nonaggressive and consistent with long survival.
Meningiomas of the lateral ventricles
Authors: Fornari Maurizio , Savoiardo Mario , Morello Giulio , Solero Carlo L.
Published: May 2009

✓ The clinical and neuroradiological findings and the surgical results in a series of 18 patients with meningiomas of the lateral ventricles, operated on over a 23-year period, are described. This experience is compared with previously reported series and the following conclusions are drawn: 1) these tumors have no characteristic symptomatology; 2) the preoperative diagnosis should be reached by means of both computerized tomography and carotid and vertebral angiography; 3) the safest surgical approach is through a sagittal paramedian parieto-occipital cortical incision; and 4) piecemeal removal is crucial for achieving total extirpation of the tumor with minimum damage of the surrounding brain tissue and for careful intraoperative hemostasis.
The efficacy of Doppler monitoring for the detection of venous air embolism
Authors: Gildenberg Philip L. , O'Brien R. Patrick , Britt William J. , Frost Elizabeth A. M.
Published: May 2009

✓ Venous air embolism can usually be detected by the use of a precordial Doppler ultrasound monitor at an air infusion rate as low as 0.015 ml/kg/min, and consistently at a rate of 0.021 ml/kg/min. This is in contrast to previously reported thresholds wherein the first physiological change, a gasp, occurs at 0.36 ml/kg/min, electrocardiographic changes first take place at 0.60 ml/kg/min, drop in blood pressure at 0.69 ml/kg/min, increased central venous pressure at 0.40 ml/kg/min, and end-tidal CO2 decreases at 0.42 ml/kg/min. The first change in heart sounds monitored through an esophageal stethoscope is not detectable until an air infusion rate of 1.70 ml/kg/min, and the classical mill-wheel murmur does not occur until 1.96 ml/kg/min. This demonstrates that Doppler ultrasound can detect venous air embolism before the earliest physiological changes, in contrast to most other methods which do not detect venous air embolism until after cardiopulmonary changes have become well established.
Experimental study of the regenerative potential of perineurium at a site of nerve transection
Authors: Behrman Jaudon E. , Acland Robert D.
Published: May 2009

✓ A single fascicle of sciatic nerve was transected in a series of rats. The nerve was repaired by one of three experimental models: 1) perineurial suturing with bulging axons untrimmed, 2) perineurial suturing with bulging axons trimmed, and 3) perineurial suturing to produce a misaligned fascicle. Nerves were excised at 0 to 42 days and were examined in thin, longitudinal section. The complete absence of perineurial regeneration was observed at all time intervals and in all models. Regeneration of axons within the fascicle was disordered. Axonal regeneration extended into the surrounding connective tissue and infiltrated both the proximal and distal perineurium.
Intradiploic cerebrospinal fluid fistula
Authors: D'Almeida Antonio C. G. , King Robert B.
Published: May 2009

✓ Two patients with asymptomatic osteolytic skull lesions were found to have cerebrospinal fluid diploic fistulas. The radiographic and operative findings have not been reported previously.
The anterior tarsal tunnel syndrome
Authors: Borges Lawrence F. , Hallett Mark , Selkoe Dennis J. , Welch Keasley
Published: May 2009

✓ Two recently encountered patients with the anterior tarsal tunnel syndrome are presented. The various aspects of this probably under-recognized syndrome are discussed. Evidence is presented that this syndrome may be the result of abnormal stretch of the deep peroneal nerve.
Parasellar epidermoid tumor presenting as painful ophthalmoplegia
Authors: Kline Lanning B. , Galbraith J. Garber
Published: May 2009

✓ In 1964, a 51-year-old man experienced a right abducens nerve palsy, which resolved spontaneously. In 1978, he developed painful ophthalmoplegia on the right with paresis of the right oculomotor and trigeminal nerves. Neuroradiographic evaluation was reported unremarkable, and the painful ophthalmoplegia was attributed to the Tolosa-Hunt syndrome. High-dose corticosteroids were administered with transient improvement of signs and symptoms. In 1979, cranial computerized tomography demonstrated a low-density lesion adjacent to the right cavernous sinus, which at operation proved to be an epidermoid tumor.
Intracavernous aneurysm of the carotid artery following transsphenoidal surgery
Authors: Cabezudo José M. , Carrillo Rafael , Vaquero Jesús , Areitio Eduardo , Martinez Roberto
Published: May 2009

✓ An intracavernous aneurysm of the left internal carotid artery arose following transsphenoidal surgery in this patient. The pathogenic, clinical, and therapeutic aspects of the case are discussed. Only four other iatrogenic intracavernous carotid aneurysms have been reported previously.
Cerebellar astrocytoma with benign histology and malignant clinical course
Authors: Auer Roland N. , Rice George P. A. , Hinton George G. , Amacher A. Loren , Gilbert Joseph J.
Published: May 2009

✓ Juvenile cerebellar astrocytoma characteristically has a very benign course and good prognosis. A case is reported of juvenile cerebellar astrocytoma with massive craniospinal leptomeningeal spread prior to surgical intervention. The patient died 8 months after the onset of symptoms and only 5 weeks after presentation to the hospital. At postmortem examination, it was found that tumor encased the brain and spinal cord. The histology was benign. The literature on cerebellar astrocytoma is reviewed.
Diffuse cerebral swelling following head injuries in children: the syndrome of “malignant brain edema”
Authors: Bruce Derek A. , Alavi Abass , Bilaniuk Larissa , Dolinskas Carol , Obrist Walter , Uzzell Barbara
Published: May 2009

✓ The commonest initial computerized tomography (CT) finding in head-injured children is bilateral diffuse cerebral swelling. Cerebral blood flow and CT density studies suggest that this swelling is due to cerebral hyperemia and increased blood volume, not to edema. The clinical history, course, and outcome of 63 children with this CT pattern are reviewed. Fourteen children had a Glasgow Coma Scale score of greater than 8; all made a complete recovery and follow-up CT scans were normal. Forty-nine children had Glasgow Coma Scale scores of 8 or less. Fifteen had a history of a lucid period following the initial unconsciousness. One of these children died of delayed brain swelling, the others recovered well with minimal neurological deficit. Thirty-four children were rendered immediately and continuously unconscious. There was a high incidence of second lesions on the CT scan, 50% of this group developed intracranial hypertension and five died. All of the others were in coma for periods ranging from weeks to months. Follow-up CT scans showed an extracerebral collection with a density of cerebrospinal fluid in 27% of the patients, and ventriculomegaly with large sulci in 35%, whereas this pattern was seen only once in those with a lucid period. The difference between those with and without a lucid period is related to the degree of primary diffuse impact injury to the white matter.
Observations on 82 patients with extradural hematoma
Authors: Cordobés Francisco , Lobato Ramiro D. , Rivas Juan J. , Muñoz María J. , Chillón Diego , Portillo Jaime M. , Lamas Eduardo
Published: May 2009

✓ A consecutive, unselected series of 82 patients with epidural hematoma treated between 1973 and 1980 is presented. Forty-one patients were managed before the advent of computerized tomography (CT) and the other 41 after this neuroradiological method was available. Mortality and disability rates which were 29.2% and 31.7% during the pre-CT period decreased to 12.1% and 19.5%, respectively, with the aid of CT scanning. This technique allowed a more rapid and accurate diagnosis of the hematomas than angiography, and defined better the presence and the evolutional changes of the associated cerebral lesions. As a consequence, surgery has been more effectively planned and executed during the CT era.
A comparison of effects of bipolar and monopolar electrocoagulation in brain
Authors: Chehrazi Bahram , Collins William F.
Published: May 2009

✓ Controlled bipolar and monopolar coagulation lesions were generated in the cerebral cortex of cats. Higher output powers were associated with larger lesions, while the lesion size was independent of the mode of coagulation. When cortical vessels were mobilized and coagulated for hemostasis, bipolar mode was associated with more rapid coagulation and less damage to the underlying brain. Higher output powers were not associated with larger lesions, probably because coagulation was more rapid. The neural damage resulting from radiofrequency current appears to be of thermal origin, and the blood-brain barrier dysfunction is a more sensitive measure of this damage than the stainable cellular changes.
Axonal transport studies of the trigeminal nerve roots of the cat
Authors: Young Ronald F. , Kruger Lawrence
Published: May 2009

✓ The transport of protein molecules by axoplasmic flow has been used to trace axonal projections in the trigeminal system of the cat. Autoradiography with tritiated amino acid labeling of synthesized proteins and the transport of the enzyme horseradish peroxidase have been employed. The latter method has enabled demonstration of afferent axons within the portio minor, some of which are of cutaneous origin. The trigeminal “motor root” thus appears to be homologous with spinal ventral roots in possessing a potentially significant sensory function. The presence of such afferent fibers in nerve roots thought previously to have an exclusively motor function may explain instances of preserved sensation or failure to relieve pain following rhizotomy of the trigeminal portio major.
Anterior encephalocele
Authors: Rapport Richard L. , Dunn Robert C. , Alhady Fareeda
Published: May 2009

✓ Eighteen cases of anterior encephalocele treated at the University of Malaya Hospital between 1970 and 1980 are discussed, and the literature concerning this defect is reviewed. A detailed analysis of the microscopic abnormalities present in the surgical specimens is included, along with the relevant radiographic and demographic data. Anterior encephalocele is more common in Southeast Asia than elsewhere. The possible ethnographic and geographic implications are presented, as well as a discussion of the relevant embryology, in attempting to define possible etiologies for this malformation. The authors' surgical approach to the repair of this defect and reasons for preferring a transcranial, intradural approach are described. Potential complications are enumerated.
Immunobiology of primary intracranial tumors
Authors: Mahaley M. Stephen , Steinbok Paul , Aronin Patricia , Dudka Lynn , Zinn Doug
Published: May 2009

✓ Levamisole was evaluated as an immune stimulant in a randomized controlled study of patients with anaplastic gliomas, who had undergone surgical resection and who were also treated with radiotherapy and BCNU chemotherapy. Of 102 patients placed into the study, 85 were determined to comprise the adequately treated group (AGT): a full course of radiotherapy and two cycles of BCNU chemotherapy. Within the ATG, those patients who received levamisole did not demonstrate significantly different serial delayed hypersensitivity reactions, peripheral blood lymphocyte and T-cell counts, or serum IgM levels, compared to those patients not receiving levamisole. There was no significant difference in survival times of the two groups. Studies utilizing the avian sarcoma virus-induced glioma in rats also showed no improvement in survival with levamisole stimulation as the only immune agent, but the combination of active immunization and adjuvant stimulation with bacillus Calmette-Guerin plus levamisole was found to be therapeutically effective in this model and will be used in future pilot studies of active immunization in patients.
Incidental pituitary adenomas
Authors: Parent Andrew D. , Bebin Jose , Smith Robert R.
Published: May 2009

✓ Pituitary glands from 500 consecutive autopsies were reviewed and the findings correlated with clinical symptomatology. Occult pituitary adenomas were identified in 42 pituitary glands (8.5%). In only one case was a pituitary lesion clinically questioned, but specific hypophyseal function studies were not performed. These tumors occurred most frequently in the sixth and seventh decade of life, without obvious sex predominance. Of these patients, 48% were obese, 57% were hypertensive, and diabetes mellitus was noted in 34%. Of the 17 cases in which skull x-ray films had been taken, suspicious or abnormal areas were found in 11. The tumor size ranged from 1 to 15 mm, but was greater than 1 cm in only one case. In 34 cases, the tumor was located along the periphery of the gland. Even though the etiological and functional significance of these tumors is unclear, the clinical course appears to be relatively benign.
Cortical blindness after cerebral angiography
Authors: Studdard William E. , Davis David O. , Young Stephen W.
Published: May 2009

✓ A case of cortical blindness after cerebral angiography is presented. Serial computerized tomography scans of the brain revealed persistence of contrast medium in occipital visual areas as well as areas that may have been associated with “focal seizures” that occurred after angiography. This case supports the concept that cortical blindness may be secondary to the direct effect of contrast medium on the brain. The persistence of contrast material was in part due to decreased renal function.
Spontaneous carotid-cavernous fistula during pregnancy or in the postpartum stage
Authors: Toya Shigeo , Shiobara Ryuzoh , Izumi Jiroh , Shinomiya Youichi , Shiga Hayao , Kimura Chojiro
Published: May 2009

✓ The authors report two cases of spontaneous carotid-cavernous fistula that occurred during pregnancy. One patient was a 21-year-old woman whose symptoms improved and in whom disappearance of the carotid-cavernous fistula was confirmed by cerebral angiography after she aborted in the 12th week of pregnancy. The other patient was a 25-year-old woman in whom a carotid-cavernous fistula occurred at about the 28th week of pregnancy. The symptoms became aggravated 3 weeks after a normal delivery. Carotid-cavernous fistula was confirmed by cerebral angiography, and the clinical symptoms then improved. On the basis of cerebral angiographic findings, both patients were considered to have dural arteriovenous fistulas in the region of the cavernous sinus and both demonstrated spontaneous improvement.
Haemophilus influenzae infections of cerebrospinal fluid shunts
Authors: Lerman Stephen J.
Published: May 2009

✓ Two (1%) of 165 episodes of Haemophilus influenzae infection of the central nervous system occurred in patients with cerebrospinal fluid shunts. Both cases were caused by strains that could not be typed. The clinical presentation was similar to that of other forms of shunt infection, yet the pathogenesis may be similar to that of H. influenzae meningitis in children without shunts. Systemic antibiotic therapy, without shunt replacement or intraventricular antibiotic administration, may be more successful in shunt infections caused by H. influenzae than in those caused by other organisms.
Disseminated intravascular coagulation as a complication of ventricular catheter placement
Authors: Shurin Susan , Rekate Harold
Published: May 2009

✓ A child who developed generalized bleeding immediately after placement of a ventriculoperitoneal shunt was found to have evidence of disseminated intravascular coagulation (DIC). Infusion of fresh frozen plasma was followed promptly by improvement in laboratory values and cessation of bleeding. Complications of the acute bleeding episode included intraventricular hemorrhage, loss of 50% of the red cell volume into subcutaneous tissues, and transient peritoneal irritation. Defibrination syndrome (that is, DIC) due to release of tissue thromboplastin is a recognized complication of trauma, particularly with brain injury. Defibrination can be induced in experimental systems with administration of very small amounts of thromboplastin, which is present in high concentration in brain tissue. This has not been described previously with minor neurosurgical procedures. The diagnosis of DIC should be considered if excessive bleeding occurs after any brain insult, since early recognition and restoration of normal hemostasis by replacement of clotting factors should prevent major complications due to ongoing hemorrhage.
Early prediction of outcome in head-injured patients
Authors: Young Byron , Rapp Robert P. , Norton J. A. , Haack Dennis , Tibbs Phillip A. , Bean James R.
Published: May 2009

✓ The relationship between Glasgow Coma Scale (GCS) scores obtained during the 1st week after head injury and outcome at 1 year was analyzed in 170 patients. Seventy-two of 76 patients with initial GCS scores of higher than 7 had favorable outcomes. Only two of the 21 patients with initial GCS scores of 3 or 4 lived, and only one had a favorable outcome. Favorable and unfavorable outcomes were almost equally divided when the initial GCS scores were in the intermediate range of 5, 6, or 7. No patients with an initial GCS score in this intermediate range that subsequently worsened had a favorable outcome, while over 80% of those improving to a score higher than 7 had a favorable outcome. Only 12% of those persisting with a score of 5, 6, or 7 for 1 week had a favorable outcome.

Outcome predictions using the multiple logistic model were made for this intermediate group of patients based on GCS scores and data on midline shift derived from computerized tomography (CT). The patients with initial scores of 5, 6, or 7 with midline shifts of less than 4.1 mm on initial CT scanning had a significantly higher favorable outcome rate compared with patients with a larger shift. However, outcome predictions made by combining shift data and initial GCS scores are not significantly more accurate than predictions based solely on initial GCS scores. Combining 48-hour GCS scores and shift data significantly improves predictive accuracy based only on coma scores. The data obtained by combining GCS scores at 72 hours and 1 week and shift data is marginally significant for improving accuracy of outcome predictions. It is concluded that GCS scores and shift data are highly accurate indicators of outcome in head-injured patients.
Long-term results of the surgical treatment of 129 intramedullary spinal gliomas
Authors: Guidetti Beniamino , Mercuri Sandro , Vagnozzi Roberto
Published: May 2009

✓ The authors report the late results of surgical treatment of 129 intramedullary gliomas (48 ependymomas, 53 astrocytomas, 13 spongioblastomas, five glioblastomas, one oligodendroglioma, and nine others), with follow-up periods ranging from 1 to 27 years. The value of surgical treatment is considered in relation to the postoperative results.
Immunobiology of primary intracranial tumors
Authors: Brooks William H. , Latta Robert B. , Mahaley M. Stephen , Roszman Thomas L. , Dudka Lynn , Skaggs Connie
Published: May 2009

✓ Long-term assessment of general host immunocompetence of patients with primary malignant brain tumors indicates that although isolated determinations of nonspecific responsiveness are not clinically useful, sequential analyses utilizing a linear combination of in vitro lymphocyte probes are capable of predicting tumor recurrence prior to clinical deterioration.
Preservation of the olfactory tract in bifrontal craniotomy for anterior communicating artery aneurysms, and the functional prognosis
Authors: Suzuki Jiro , Yoshimoto Takashi , Mizoi Kazuo
Published: May 2009

✓ Results of surgical treatment of anterior communicating artery aneurysms, approached via bifrontal craniotomy, are reported in 110 cases. It was possible to preserve the olfactory tracts bilaterally or unilaterally in over 65% of these cases: 47% with bilateral preservation and 34% with unilateral preservation; 33% of the patients with bilateral olfactory tract damage reported subjectively normal olfaction. Objective examination of olfaction by an otolaryngologist showed that 84% of the patients reporting normal olfaction did indeed have normal olfaction, whereas 91% of these reporting no olfaction were anosmic.
The effect of a lipid hydroperoxide of arachidonic acid on the canine basilar artery
Authors: Sasaki Tomio , Wakai Susumu , Asano Takao , Watanabe Takashi , Kirino Takaaki , Sano Keiji
Published: May 2009

✓ The in vivo spasmogenic capacity of a lipid hydroperoxide (15-hydroperoxy arachidonic acid: 15-HPAA) was studied in a chronic experiment using the dog. The 15-HPAA was injected into the cisterna magna (0.2 or 2 mg emulsified in bovine serum albumin solution). The changes in diameter of the basilar artery were followed by angiography, and the morphological changes were studied by electron microscopy. The cisternal injection of 0.2 mg of 15-HPAA caused a mild constriction of the basilar artery which lasted about 7 hours. The cisternal injection of 2 mg of 15-HPAA caused a biphasic constriction, the initial phase of which was a moderate narrowing lasting about 10 hours. The second phase started on the 2nd or the 3rd day after injection. The intensity of the arterial narrowing was more pronounced in the second phase than in the first. The prolonged secondary constriction of the basilar artery continued until sacrifice on the 7th day after injection.

Electron microscopic study revealed a marked degenerative change in the endothelium and myonecrotic changes in the tunica media. The prolonged arterial constriction in the second phase was invariably associated with remarkable degeneration of the endothelium. On the other hand, myonecrotic changes were limited to a small number of smooth-muscle cells.

The results of the present study are consonant with the hypothesis that lipid peroxidation associated with lysis of the subarachnoid clot is involved in the genesis of chronic vasospasm in subarachnoid hemorrhage.
Syringomyelia: long-term results after posterior fossa decompression
Authors: Garcìa-Uria Josè , Leunda Guillermo , Carrillo Rafael , Bravo Gonzalo
Published: May 2009

✓ A retrospective study of the surgical results in 31 adult patients with syringomyelia associated with Arnold-Chiari malformation was carried out. The standard surgical procedure consisted of a posterior fossa craniectomy. The vallecula was opened in 28 patients, with plugging of the central canal in 19. In three patients, severe arachnoidal scarring was present, and dissection was not attempted. The postoperative follow-up period ranged from 5 to 10 years. More than half of the patients considered themselves improved by surgery; however, only five cases showed objective improvement. Despite the operation, six patients experienced progressive neurological deterioration.
Bilateral internuclear ophthalmoplegia associated with fourth ventricular epidermoid tumor
Authors: Schraeder Paul L. , Cohen Michael M. , Goldman Warren
Published: May 2009

✓ A 49-year-old woman with multiple sclerosis diagnosed by her classical clinical history and bilateral internuclear ophthalmoplegia was found to have an epidermoid tumor of the fourth ventricle. Removal of the tumor resulted in resolution of her neurological symptoms and signs.
Neurofibrosarcoma of the cauda equina
Authors: Thomeer Raphael T. W. M. , Bots Gerard Th. A. M. , van Dulken Hans , Luyendijk Willem , Helle Peter
Published: May 2009

✓ A case of a malignant neurofibroma of the cauda equina is described. Its location seems to be rare. An extensive surgical resection including the adjacent neural tissue and the enveloping dural sac was carried out, followed by radiotherapy.
Neoplastic angioendotheliosis: a clinicopathological entity with multifocal presentation
Authors: Ansbacher Linda , Low Nancy , Beck David , Boarini David , Jacoby Charles , Cancilla Pasquale A.
Published: May 2009

✓ Neoplastic angioendotheliosis is a rare disorder characterized by intravascular neoplastic proliferation of endothelial cells within vessels of all caliber in the meninges and neuropil. Ischemic infarcts of brain and spinal cord result from occlusion of the lumina by neoplastic cells or fibrin thrombi. Transition from reactive to neoplastic endothelium can be identified in many vessels. Steroid therapy can be beneficial in reduction of severity of symptoms, but cannot alter the course of disease. Therapeutic intervention must be undertaken promptly after the diagnosis is confirmed by meningeal and cortical biopsy if the inexorable course of the disease is to be altered.
A precise technique for craniotomy localization using computerized tomography
Authors: Hinck Vincent C. , Clifton Guy L.
Published: May 2009

✓ The authors describe a simple device which, when used with computerized tomography, provides precise preoperative localization of craniotomy.
High-dose BCNU with autologous bone marrow rescue for recurrent glioblastoma multiforme
Authors: Hochberg Fred H. , Parker Leroy M. , Takvorian Tak , Canellos George P. , Zervas Nicholas T.
Published: May 2009

✓ Eleven patients with recurrent malignant glioma were treated with single high doses of BCNU ranging from 600 to 1400 mg/sq m. To prevent the characteristic late myelosuppression observed after conventional doses of BCNU, autologous bone marrow harvested just before drug treatment was infused 24 to 36 hours after therapy. Higher doses of BCNU causes earlier and more profound myelosuppression; one patient died of pancytopenia, breakdown of the gut epithelium, and Clostridium septicemia 10 days after receiving 1400 mg/sq m of BCNU. All patients experienced transient emesis; four developed transient elevation of hepatic enzymes, two reversible interstitial pulmonary infiltrates, and two who received 1400 mg/sq m BCNU suffered irreversible cortical damage. Eight patients receiving 600 to 1200 mg/sq m demonstrated reconstitution of polymorphonuclear leukocytes and platelets within at least 30 days after treatment. With a follow-up time of up to 19 months, four patients improved, three stabilized, and three deteriorated and died. The median survival time was 7 months. Computerized tomography performed on patients receiving constant corticosteroids showed diminished contrast enhancement and mass effect in eight patients. High-dose BCNU at doses up to 1200 mg/sq m with marrow rescue is a feasible approach to the treatment of patients with glioblastoma.
Intracranial pressure in nontraumatic ischemic and hypoxic cerebral insults
Authors: Senter Howard J. , Wolf Aizik , Wagner Franklin C.
Published: May 2009

✓ Intracranial pressure (ICP) and cerebral perfusion pressure were monitored in 12 patients who were comatose secondary to hypoxic (five cases) or hypotensive (seven cases) nontraumatic cerebral insults. Patients who were hypotensive but not hypoxic developed significant increased ICP. In patients who were comatose from hypoxic cerebral insults without hypotension, ICP was normal. When an increase in ICP was diagnosed, patients were managed aggressively so as to improve cerebral perfusion and lower ICP. Although a functional salvage rate of 25% was obtained, this may reflect the severity of the initial cerebral insult rather than the effect of treatment. In order to prevent the potential deleterious effects of raised ICP, it is concluded that monitoring ICP and maintaining adequate perfusion may be warranted in comatose patients who have suffered nontraumatic diffuse ischemic but not purely hypoxic cerebral insults.
Pathophysiology of “tethered cord syndrome”
Authors: Yamada Shokei , Zinke David E. , Sanders Delmar
Published: May 2009

✓ The tethered cord syndrome is a clinical entity manifested by progressive motor and sensory changes in the legs, incontinence, back or leg pain, and scoliosis. In order to elucidate the pathophysiology involved in the tethered cord, the reduction/oxidation ratio (redox) was used in vivo of cytochrome a,a3 to signal oxidative metabolic functioning in human examples of tethered cord and in animal models. Studies in experimental models indicate marked metabolic and electrophysiological susceptibility to hypoxic stress to lumbosacral cord under traction with greater weights (3, 4, or 5 gm). Similar effects were demonstrated in redox behavior of human tethered cord during surgical procedures. The authors conclude that symptoms and signs of tethered cord are concomitant with lumbosacral neuronal dysfunction which could be due to impairment of mitochondrial oxidative metabolism under constant or intermittent cord stretching. It is assumed that prolonged or accentuated neuronal dysfunction may lead to structural damage to the neuronal perikarya and later of the axons. Untethering procedures in human tethered cord improve oxidative metabolism, and probably facilitate the repair mechanism of injured neurons.
Benign enlargement of the subarachnoid spaces in the infant
Authors: Ment Laura R. , Duncan Charles C. , Geehr Robert
Published: May 2009

✓ The authors report 18 infants with benign enlargement of the subarachnoid spaces seen at their institution during a 1-year time interval. This condition is characterized by the computerized tomography findings of dilatation of the subarachnoid spaces, normal or slightly enlarged ventricular size, and prominence of the basilar cisterns. Most cases were found in children referred for the evaluation of abnormally increasing head circumference measurements. Although it was not possible to document the development, and, in several cases, improvement of this process, in these patients enlargement of the subarachnoid spaces was a benign diagnosis, not associated with serious neurological dysfunction.
Contralateral ventricular dilatation in supratentorial tumors
Authors: Findlay Gordon F. G. , Cummins Brian H.
Published: May 2009

✓ The computerized tomographic (CT) scans of 411 patients with supratentorial lateralized tumors were compared with an assessment of their clinical condition. More than one-third of these patients showed dilatation of the contralateral lateral ventricle, which was associated with a lower level of consciousness.
Intrachiasmatic arteriovenous malformation
Authors: Roski Richard A. , Gardner John H. , Spetzler Robert F.
Published: May 2009

✓ A patient presented with an abrupt monocular decrease in visual acuity and a bitemporal hemianopsia. At surgery, a totally intrachiasmatic arteriovenous malformation was removed, with subsequent resolution of the visual deficit.
Actinomycotic granuloma of the Gasserian ganglion with primary site in a dental root
Authors: Perna Enrico , Liguori R. , Petrone G. , Mannarino E.
Published: May 2009

✓ An unusual case of cerebral actinomycosis of the Gasserian ganglion is reported. The location and the pathological diagnosis of granuloma are both extremely rare. The literature is briefly reviewed with special reference to similar reports. The manner of spread and the course of the disease are described. The present case tends to confirm the opinion that primary cerebral actinomycosis is extremely rare and probably does not exist. The case also definitely indicates that the organism reaches the central nervous system by way of nerve or perineural pathways.
A noninvasive approach to quantitative measurement of flow through CSF shunts
Authors: Stein Sherman C. , Apfel Stewart
Published: May 2009

✓ A method of measuring flow rate through cerebrospinal fluid (CSF) shunts is reported. It consists of two thermistors in series applied to the skin over the shunt tubing. The thermistors respond by a drop in measured temperature following application of an ice cube placed on the skin overlying the proximal shunt tube. The time required for the thermal response to travel between the two thermistors is related to the velocity of flow through the shunt tubing. Flow rate can then be calculated using the internal diameter of the tubing. A series of animal experiments employing a constant infusion of mock CSF through subcutaneously implanted shunt tubing showed excellent correlation between calculated flow rates and actual infusion rates. The device is noninvasive and easily adapted to use in patients. The measurements are readily repeatable.
A new method for the measurement of brain surface movement
Authors: Toutant Steven M. , Todd Michael M. , Shapiro Harvey M.
Published: May 2009

✓ An easily used, sensitive, and highly accurate method of measuring movement of the exposed brain surface is described. The technique may be useful to both neurophysiologists and neurosurgeons.
Chronic subdural hematomas: a review
Authors: Markwalder Thomas-Marc
Published: May 2009

✓ Present knowledge of the still controversial pathogenetic, ultrastructural, diagnostic, and treatment aspects of chronic subdural hematomas is reviewed.
Gelfoam paste in experimental laminectomy and cranial trephination
Authors: Wilkinson Harold A. , Baker Steve , Rosenfeld Steven
Published: May 2009

✓ The hemostatic properties and effect on osteogenesis of gelatin foam paste and bone wax were compared on surgical bone lesions in experimental animals. Thirty rabbits each received four trephine craniotomies and four lumbar laminectomies. Alternate bone incisions in each animal were treated with either gelatin foam paste or bone wax. Blood loss was measured by absorbing the blood into dry surgical cottonoids weighed before and after use. Bone healing sites of three rabbits were examined histologically to assess the effect of each agent on osteogenesis. The trephination sites of eight rabbits were subjected to fracture force testing at 6 weeks postoperatively to compare the effect to the two agents on bone healing. No significant difference was found between gelatin foam paste and bone wax in either effectiveness of hemostasis or effect on osteogenesis.
Multiple cerebral arteriovenous malformations associated with soft-tissue vascular malformations
Authors: Hanieh Ahmed , Blumbergs Peter C. , Carney Paul G.
Published: May 2009

✓ A patient found unconscious, probably due to a seizure, was discovered to have two intracranial arteriovenous malformations. Multiple arteriovenous malformations is a rare condition, and both lesions were excised successfully.
Mycotic aneurysm of the intracavernous portion of the carotid artery in childhood
Authors: Tomita Tadanori , McLone David G. , Naidich Thomas P.
Published: May 2009

✓ A mycotic aneurysm of the intracavernous portion of the carotid artery produced total ophthalmoplegia in a 2-year-old boy. Serial angiography displayed progressive enlargement of the aneurysm which was successfully treated by carotid ligation. Angiography is mandatory to rule out carotid artery complications secondary to cavernous sinus thrombophlebitis.
Cryptococcal skull granuloma
Authors: Galloway Dan C. , Schochet Sydney S.
Published: May 2009

✓ A patient with a cryptococcal skull granuloma is presented, and the radiological differential diagnosis is discussed.
Neurinomas of the jugular foramen in children
Authors: Martínez Roberto , Vaquero Jesús , Cabezudo José , Areitio Eduardo , Bravo Gonzalo
Published: May 2009

✓ Two cases of neurinomas of the jugular foramen in patients under 16 years of age are presented. Neurinomas of this location have not been previously reported in children.
Communicating hydrocephalus in newborn hamsters and cats following vaccinia virus infection
Authors: Davis Larry E.
Published: May 2009

✓ Newborn hamsters and kittens infected with vaccinia virus developed communicating hydrocephalus without fibrotic changes in the meninges. Following intracerebral viral inoculation, a transient inflammation of the meninges, ependyma, and choroid plexus was found. One month later, 70% of hamsters infected with the WR strain of vaccinia virus and 35% infected with the vaccine strain developed hydrocephalus. The mechanism of hydrocephalus production is unclear, but differs from other models in which it is associated with stenosis of the aqueduct of Sylvius or fibrosis of the subarachnoid space.
Thresholds of focal cerebral ischemia in awake monkeys
Authors: Jones Thomas H. , Morawetz Richard B. , Crowell Robert M. , Marcoux Frank W. , FitzGibbon Stuart J. , DeGirolami Umberto , Ojemann Robert G.
Published: May 2009

✓ An awake-primate model has been developed which permits reversible middle cerebral artery (MCA) occlusion during physiological monitoring. This method eliminates the ischemia-modifying effects of anesthesia, and permits correlation of neurological function with cerebral blood flow (CBF) and neuropathology. The model was used to assess the brain's tolerance to focal cerebral ischemia. The MCA was occluded for 15 or 30 minutes, 2 to 3 hours, or permanently. Serial monitoring evaluated neurological function, local CBF (hydrogen clearance), and other physiological parameters (blood pressure, blood gases, and intracranial pressure). After 2 weeks, neuropathological evaluation identified infarcts and their relation to blood flow recording sites.

Middle cerebral artery occlusion usually caused substantial decreases in local CBF. Variable reduction in flow correlated directly with the variable severity of deficit. Release of occlusion at up to 3 hours led to clinical improvement. Pathological examination showed microscopic foci of infarction after 15 to 30 minutes of ischemia, moderate to large infarcts after 2 to 3 hours of ischemia, and in most cases large infarcts after permanent MCA occlusion. Local CBF appeared to define thresholds for paralysis and infarction. When local flow dropped below about 23 cc/100 gm/min, reversible paralysis occurred. When local flow fell below 10 to 12 cc/100 gm/min for 2 to 3 hours or below 17 to 18 cc/100 gm/min during permanent occlusion, irreversible local damage was observed.

These studies imply that some cases of acute hemiplegia, with blood flow in the paralysis range, might be improved by surgical revascularization. Studies of local CBF might help identify suitable cases for emergency revascularization.
Technique of catheterization and embolization of the lenticulostriate arteries
Authors: Berenstein Alex
Published: May 2009

✓ The technique of catheterization and embolization of the lateral and medial lenticulostriate arteries, using one or two balloon catheters of various designs, is described. A case of a bilateral thalamic arteriovenous malformation is presented and a further instance of an aneurysm of a striate artery is briefly discussed. Because of the high probability of proximal middle cerebral artery (MCA) thrombosis, care must be taken to determine tolerance to MCA occlusion prior to embolization.