bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic third ventriculostomy for obstructive hydrocephalus due to intracranial hemorrhage with intraventricular extension
Authors: Oertel Joachim M. K. , Mondorf Yvonne , Baldauf Joerg , Schroeder Henry W. S. , Gaab Michael R.
Published: May 2009

Object

Endoscopic third ventriculostomy (ETV) is well accepted for obstructive hydrocephalus of various etiologies. Nevertheless, it is seldom considered in intracranial hemorrhage even in cases involving obstruction of the CSF circulation.

Methods

Between May 1993 and April 2008, 34 endoscopic procedures were performed for hemorrhage-related obstructive hydrocephalus with an intraventricular component. All patients were prospectively followed up. Special attention was paid to presurgical clinical status, type of hemorrhage, type of surgery, postsurgical clinical status, postsurgical ventricular size, and necessity of ventriculoperitoneal shunt implantation.

Results

An ETV was performed for treatment of obstructive hydrocephalus due to intracranial hemorrhage in 34 patients (15 male, 19 female; mean age 60.8 years [range 3 months–83 years]). Hydrocephalus was caused by 17 cerebellar, 6 thalamic, 5 intraventricular, 3 basal ganglia, 2 subarachnoid, and 1 pontine hemorrhage. Thirty-three patients (97.1%) presented with impaired consciousness. Intraventricular blood was present in all cases. In 16 cases (47.1%), blood clots had to be evacuated to achieve access to the third ventricle floor. The mean operation time was 58.2 minutes (range 25–120 minutes). Three complications occurred (rate of 8.8%) with 2 being asymptomatic (5.9%) and 1 being transient (2.9%). There was no procedure-related permanent morbidity, and no procedure-related mortality. After surgery, there was clinical improvement in 17 cases (50.0%) and radiological evidence of improvement in 22 cases (64.7%). Two patients required postoperative ventriculoperitoneal shunting (5.9%). Seven patients died of hemorrhage while in the hospital (20.6%), and another 4 died during follow-up (11.8%). Fifteen patients (44.1%) showed a persistent clinical improvement at the final follow-up (mean 12.2 months after surgery).

Conclusions

Endoscopic third ventriculostomy represents a safe treatment option in intraventricular hemorrhage–related obstructive hydrocephalus yielding similar results as an external drainage but with less risk of infection and a very low subsequent shunt placement rate. In cases with a predominant obstructive component, ETV should be considered in hydrocephalus due to intracerebral hemorrhage. However, performing an ETV with a blurred field of vision and distorted ventricular anatomy is a challenge for any endoscopic neurosurgeon and should be reserved for experienced neuroendoscopists.
Intravascular coagulation: a common phenomenon in minor experimental head injury
Authors: van der Sande J. Jaap , Emeis Josephus J. , Lindeman Jan
Published: May 2009

✓ Fibrin microthrombi were demonstrated by an immunoenzymehistochemical method in the small blood vessels of the lung and, to a lesser extent, in the brain in rats after minor experimental head injury. It was concluded that intravascular coagulation is a common phenomenon in head injury.
Multiple abscesses of the brain
Authors: Kobrine Arthur I. , Davis David O. , Rizzoli Hugo V.
Published: May 2009

✓ A case of multiple brain abscesses is presented. The patient was treated with systemic antibiotics; one of the lesions acutely increased in size, became life-threatening, and was surgically removed. The patient continued with antibiotic treatment, and the remaining brain abscesses completely disappeared. Recent follow-up review almost 2 years after diagnosis demonstrated no evidence of recurrence.
Congenital ventriculocisternostomy
Authors: Mann Kirpal S. , Khosla Virender K. , Gulati Des R.
Published: May 2009

✓ A case of congenital ventriculocisternostomy is reported. This infant presented with occipital meningocele. Conray ventriculography demonstrated a spontaneous ventriculocisternostomy and stenosis of the aqueduct. The case is discussed and pertinent literature reviewed.
Proatlantal intersegmental artery with absence of bilateral vertebral arteries
Authors: Tsukamoto Sumio , Hori Yutaka , Utsumi Shozaburo , Tanigake Tatsuo , Horiike Nobuo , Otani Ryoichi
Published: May 2009

✓ A case of proatlantal intersegmental artery with absence of bilateral vertebral arteries is presented. This rare anomaly was accidentally encountered on angiography in a patient with a ruptured aneurysm of the anterior communicating artery.
Microsurgical anatomy of the middle cerebral artery
Authors: Gibo Hirohiko , Carver Christopher C. , Rhoton Albert L. , Lenkey Carla , Mitchell Robert J.
Published: May 2009

✓ The microsurgical anatomy of the middle cerebral artery (MCA) was defined in 50 cerebral hemispheres. The MCA was divided into four segments: the M1 (sphenoidal) segment coursed posterior and parallel to the sphenoid ridge; the M2 (insular) segment lay on the insula; the M3 (opercular) segment coursed over the frontoparietal and temporal opercula; and the M4 (cortical) segment spread over the cortical surface. The Sylvian fissure was divided into a sphenoidal and an operculoinsular compartment. The M1 segment coursed in the sphenoidal compartment, and the M2 and M3 segments coursed in the operculoinsular compartment. The main trunk of the MCA divided in one of three ways: bifurcation (78% of hemispheres), trifurcation (12%), or division into multiple trunks (10%). The MCA's that bifurcated were divided into three groups: equal bifurcation (18%), inferior trunk dominant (32%), or superior trunk dominant (28%). The MCA territory was divided into 12 areas: orbitofrontal, prefrontal, precentral, central, anterior parietal, posterior parietal, angular, temporo-occipital, posterior temporal, middle temporal, anterior temporal, and temporopolar. The smallest cortical arteries arose at the anterior end and the largest one at the posterior end of the Sylvian fissure. The largest cortical arteries supplied the temporo-occipital and angular areas. The relationship of each of the cortical arteries to a number of external landmarks was reviewed in detail.
Intraspinal extradural sensory rhizotomy in patients with failure of lumbar disc surgery
Authors: Strait Timothy A. , Hunter Samuel E.
Published: May 2009

✓ Questionnaires were sent to 60 patients who had undergone an intraspinal extradural sensory rhizotomy after failure of back surgery to assess the efficacy of the procedure. Questionnaires were returned from 47 patients. The operative results were uniformly poor in improving the level of activity of the patient. However, nearly 60% of the patients obtained relief of their pain. Section of only one root, either L-5 or S-1, relieved pain in 50% of the cases. Section of both roots, L-5 and S-1, appeared more effective, since 66% of these patients were relieved of their pain. The technique of performing an intraspinal extradural sensory rhizotomy is discussed in detail.
Cellolite (Merocel): a new form of neurosurgical patty
Authors: Meyer Carl H. A. , Joglekar Vijay M.
Published: May 2009

✓ Cellolite and cottonoid were compared with regard to histological reactions provoked when they were left in contact with the rat brain. Pieces of each material were implanted in 27 rats either extra- or intracerebrally for 48 hours or 28 days. Histological findings suggest that the use of Cellolite for neurosurgery would be unlikely to cause adverse reactions any worse than those caused by cottonoid.
Radiation therapy of a choroid plexus papilloma of the cerebellopontine angle with bone involvement
Authors: Naguib Mahmoud G. , Chou Shelley N. , Mastri Angeline
Published: May 2009

✓ A case is reported of cerebellopontine angle choroid plexus papilloma with overlying bone destruction. Its favorable response to radiation therapy following subtotal excision is described.
Further experience in the management of severe head injury
Authors: Miller J. Douglas , Butterworth John F. , Gudeman Steven K. , Faulkner J. Edward , Choi Sung C. , Selhorst John B. , Harbison John W. , Lutz Harry A. , Young Harold F. , Becker Donald P.
Published: May 2009

✓ A prospective and consecutive series of 225 patients with severe head injury who were managed in a uniform way was analyzed to relate outcome to several clinical variables. Good recovery or moderate disability were achieved by 56% of the patients, 10% remained severely disabled or vegetative, and 34% died. Factors important in predicting a poor outcome included the presence of an intracranial hematoma, increasing age, abnormal motor responses, impaired or absent eye movements or pupil light reflexes, early hypotension, hypoxemia or hypercarbia, and elevation of intracranial pressure over 20 mm Hg despite artificial ventilation. Most of these predictive factors were assessed on admission, but a subset of 158 patients was identified in whom coma was present on admission and was known to have persisted at least until the following day. Although the mortality in this subset (40%) was higher than in the total series, it was lower than in several comparable reported series of patients with severe head injury. Predictive correlations were equally strong in the entire series and in the subset of 158 patients with coma. A plea is made for inclusion in the definition of “severe head injury” of all patients who do not obey commands or utter recognizable words on admission to the hospital after early resuscitation.
Experimental study of high-resolution ultrasound imaging of hemorrhage, bone fragments, and foreign bodies in head trauma
Authors: Enzmann Dieter R. , Britt Richard H. , Lyons Bernie , Buxton T. L. , Wilson D. A.
Published: May 2009

✓ The accuracy of high-resolution ultrasound scans in detecting foreign bodies and hemorrhage within the brain was evaluated by comparison with computerized tomography (CT) scans and gross pathology. The test lesions were blood and foreign bodies consisting of bone, wood, and metal placed in the brain of an experimental animal. High-resolution ultrasound scans (10 MHz) performed in coronal and sagittal planes accurately delineated the position and spatial orientation of these foreign bodies and hemorrhage. Both hemorrhage and foreign bodies were echogenic compared to normal, hypoechoic brain parenchyma. Metal fragments had a highly characteristic echo pattern caused by sound reverberation within the object. Acute intracerebral hemorrhage produced an ultrasound image consisting of sharply circumscribed homogeneous echoes. The sonographic shape of intracerebral hemorrhage correlated closely with the area of increased density seen on the CT scan. High-resolution ultrasonography accurately delineated experimentally produced components of head trauma and may prove useful as an intraoperative imaging technique to facilitate surgery in head-injured patients.
Needle biopsy of tumors in the region of the third ventricle
Authors: Rekate Harold L. , Ruch Teresa , Nulsen Frank E. , Roessmann Uros , Spence James
Published: May 2009

✓ Twenty-six patients underwent needle biopsy of tumors in the area of the third ventricle. Operative mortality was zero, and the diagnosis was established in 23 of the 26 patients. There was no permanent neurological deterioration in any of the patients. Needle biopsy yields diagnostic information with small risk, and is particularly helpful in the posterior portion of the third ventricle where tumors are likely to be quite radiosensitive.
New angled fenestrated clips for fusiform vertebral artery aneurysms
Authors: Sugita Kenichiro , Kobayashi Shigeaki , Inoue Toshiki , Banno Tatsuo
Published: May 2009

✓ New angled fenestrated clips are introduced for surgery of certain difficult aneurysms. Their usefulness was proven in two cases of fusiform vertebral artery aneurysms. The aneurysms were obliterated, new parent arteries were reconstructed, and the inclusion of adjacent vital nerves and vessels in the clips was avoided. Technical problems associated with the application of these clips are discussed.
Vasoconstrictive effects of human post-hemorrhagic cerebrospinal fluid on cat pial arterioles in situ
Authors: Brandt Lennart , Ljunggren Bengt , Andersson Karl-Erik , Hindfelt Bengt , Teasdale Graham
Published: May 2009

✓ Cat cortical arterioles were exposed in vivo to cerebrospinal fluid (CSF) from four patients with subarachnoid hemorrhage (SAH) due to a ruptured intracranial aneurysm. Pial arteriolar caliber was measured by the television image-splitting technique. There was a consistent vasoconstrictive response to CSF. This effect could be ascribed neither to the pH of the CSF nor to the potassium concentration. The vasoconstriction, which was more pronounced with decreasing arteriolar caliber, could be resolved by the perivascular application of nifedipine.
Computerized tomography studies of congenital and acquired cerebral intraventricular membranes
Authors: Savolaine Edward R. , Gerber Arthur M.
Published: May 2009

✓ The role of intraventricular membranes in recurrent shunt failure is explored in two cases using computerized tomography (CT) with intraventricular metrizamide and air ventriculography. One patient who had hydrocephalus with congenital intraventricular membranes containing neurons had a good ultimate response, although he had undergone seven shunt revisions before the membranes were discovered. The other patient with postventriculitis membranes had a complicated course. The effects of shunt malposition and intraventricular antibiotic treatment are discussed. It is determined that certain clues from CT scans, plain film, and air ventriculography may indicate the presence of membranes contributing to repeated shunt failure and that the use of intraventricular metrizamide with CT facilitates the diagnosis.
Intratumoral hemorrhage in posterior fossa tumors after ventricular drainage
Authors: Vaquero Jesús , Cabezudo José M. , de Sola Rafael G. , Nombela Luis
Published: May 2009

✓ Severe intratumoral hemorrhage in posterior fossa tumors is reported in two children, one with a Grade I astrocytoma, and the other with a medulloblastoma. Fatal bleeding occurred a few hours after insertion of ventricular drainage for preoperative management of obstructive hydrocephalus.
Cushing's legacy to transsphenoidal surgery
Authors: Rosegay Harold
Published: May 2009

✓ Cushing's experience with the surgical treatment of pituitary adenomas and other lesions producing the chiasmal syndrome is reviewed. The conclusion is that his ultimate rejection of the transsphenoidal route was not due to his dissatisfaction with this procedure, but rather came about because the transfrontal route provided him with access to the pituitary and, at the same time, enabled him to verify all suprasellar tumors if the preoperative diagnosis was uncertain. Until he gave it up in 1929, Cushing used the transsphenoidal route preferentially when the sella was large. Some of his assistants in the clinic, notably Norman Dott, came away with a high and lasting regard for the operation, and Dott's subsequent influence on Gérard Guiot is a crucial link in the return of transsphenoidal surgery to its current preeminent position.
Hypothesis testing in neurosurgical trials
Authors: Sundaresan Narayan , Voorhies Rand , Kwok Kui-Lam , Thaler H. Tzvi
Published: May 2009

✓ Controlled clinical trials represent the most scientific method of evaluating a new form of treatment. In designing such a trial, one must avoid committing two kinds of errors. The Type I error is defined as falsely concluding that a difference between two treatments exists, when they are equal. The Type II error is committed when one concludes that two treatments are the same, when a real difference exists. To reduce the probability of committing these errors, large sample sizes are required. A survey of neurosurgical trials showed that the majority of these trials have an unacceptably high probability of committing a Type II error because of inadequate sample size.
Lumbar disc protrusion in children
Authors: Fisher Robert G. , Saunders Richard L.
Published: May 2009

✓ Forty-three cases of surgically treated lumbar disc protrusion in patients 21 years or younger are analyzed. The results were generally good. Ten percent of the patients required reoperation within 3 years. No major complications were experienced. Follow-up observation ranged from 4 to 30 years. Disc protrusion should be considered in the differential diagnosis of children with back and sciatic pain, and early myelography should be carried out in the refractory case. The symptoms, signs, myelograms, and surgical findings are usually similar to those of the adult patient with a disc protrusion.
Effect of pentobarbital on the reactivity of isolated human cerebral arteries
Authors: Marín Jesús , Lobato Ramiro D. , Rico Mercedes L. , Salaices Mercedes , Benitez Julio
Published: May 2009

✓ The authors have analyzed the effect of pentobarbital (10−5M to 10−3M) on the contractile activity of isolated human cerebral arteries. Pentobarbital was found to inhibit both the spontaneous mechanical activity and the basal tone of these vessels. Relaxation induced by this drug was dose-dependent, and was more marked when the arterial tone was previously increased with noradrenalin, potassium chloride, or 5-hydroxytryptamine. In addition, pentobarbital inhibits, in a dose-dependent manner, the contractions elicited by these vasoconstrictor agents. The present findings indicate that barbiturates decrease cerebrovascular reactivity, and disagree with the hypothesis that these drugs reduce raised intracranial pressure by means of exerting a direct constrictive effect on the cerebral arteries.
Paraspinal myxoma with spinal cord compression
Authors: Tahmouresie Ali , Farmer Peter M. , Stokes Norman
Published: May 2009

✓ A patient with thoracolumbar paraspinal muscle myxoma with spinal cord compression presented with a long history of back pain and recent paraparesis. Removal of the tumor and decompression of the spinal cord provided marked improvement of the weakness.
Pasteurella multocida subdural empyema
Authors: Stern Jack , Bernstein Carol A. , Whelan Margaret A. , Neu Harold C.
Published: May 2009

✓ The authors report a case of subdural empyema caused by the organism Pasteurella multocida. The clinical course is outlined, and the etiology and treatment are discussed.
Influence of changes in arterial pCO2 on cerebral blood flow and metabolism during high-dose barbiturate therapy in dogs
Authors: Kassell Neal F. , Hitchon Patrick W. , Gerk Mary K. , Sokoll Martin D. , Hill Todd R.
Published: May 2009

✓ In 13 dogs the response of the cerebral circulation to changes in PaCO2 ranging from 20 to 60 torr was studied before and after administration of high doses of sodium thiopental. Infusion of sufficient barbiturate to produce 30- to 60-second burst suppression in the electroencephalogram was associated with a profound degree of cerebral vasoconstriction, equivalent to that produced by hypocapnia with PaCO2 = 20 torr. Furthermore, once sodium thiopental was administered, no significant difference in cerebral blood flow (CBF) or vascular resistance (CVR) was noted between PaCO2 of 30 and 20 torr. However, changes of approximately 15% in CBF and 30% in CVR were noted between PaCO2 at 40 and 20 torr. These data suggest that hyperventilation of PaCO2 of less than 30 torr may not effectively increase the degree of cerebral vasoconstriction in these circumstances.
Transkull focal lesions in cat brain produced by ultrasound
Authors: Fry Francis J. , Goss Stephen A. , Patrick James T.
Published: May 2009

✓ Focused ultrasound has been used for focal modifications of brain tissue and in preliminary studies of the application of ultrasonic techniques for tissue modification in human stereotaxic neurosurgery; however, the technique has been seriously compromised by the necessity of removal of intervening skull. Such removal was necessary to avoid distortion and extremely large attenuation of the ultrasonic beam which resulted from passage through bone. Recent studies have shown that under proper conditions focal beams of ultrasound can be transmitted with tolerable distortion and attenuation through skull, suggesting the possibility of transkull lesion production in brain.

This report describes the acoustical parameters and histological features of focal brain lesions produced in 10 craniectomized cats with intense focal ultrasonic beams which first had passed through a formalin-fixed human skull overlay. The histological appearance of these lesions produced to date is similar to that produced previously without intervening skull.
Prevention of postoperative complications after a transoral transclival approach to basilar aneurysms
Authors: Hayakawa Toru , Kamikawa Kiyoo , Ohnishi Toshiteru , Yoshimine Toshiki
Published: May 2009

✓ The authors describe the techniques employed in three patients with basilar artery aneurysms that were treated via the transoral transclival approach. To prevent the formation of cerebrospinal fluid fistulas and the risk of consequent meningitis, complete postoperative closure of the nasopharyngeal mucosa is essential. Long-term nasopharyngeal packing and continuous spinal drainage were found to be effective in these cases.
Malleable microsurgical suction device
Authors: Spetzler Robert F. , Iversen Alfred A.
Published: May 2009

✓ A malleable microsurgical suction device is presented which allows continuous drainage of cerebrospinal fluid or blood from an operative site. A malleable wire incorporated into the plastic tubing allows placement and readjustment of the suction tip to keep it where desired.
Chemotherapy of pediatric brain-stem tumors
Authors: Fulton Dorcas S. , Levin Victor A. , Wara William M. , Edwards Michael S. , Wilson Charles B.
Published: May 2009

✓ Forty-five children harboring brain-stem tumors were treated at the University of California, San Francisco, between 1969 and 1979. Pathological diagnoses were made in 19 patients. All patients received radiation therapy (RT). Thirteen patients received chemotherapy before, during, or immediately after RT. Twenty-four patients were treated with chemotherapy at the time of tumor progression, after initial treatment with RT alone. No statistically significant difference in time to tumor progression or survival was found for treatment with chemotherapy as an adjuvant to RT compared to treatment with RT alone followed by chemotherapy administered at the time of tumor progression. There were, however, more long-term survivors in the group that was first treated with chemotherapy at the time of tumor progression. There was no statistically significant correlation between survival and tumor pathology or location, although there were more long-term survivors among patients harboring low-grade gliomas and among patients with tumors confined to the midbrain. The authors documented the response of some brain-stem tumors to chemotherapy; however, cooperative controlled studies will be required to determine the optimum treatment for this disease.
Pharmacokinetics of epsilon-aminocaproic acid during peritoneal dialysis
Authors: Fish Susan S. , Pancorbo Salvador , Berkseth Robert
Published: May 2009

✓ Two patients requiring peritoneal dialysis were treated with epsilon-aminocaproic acid (EACA), an antifibrinolytic agent. Samples of serum and dialysate were assayed for EACA concentrations. Total body clearance, dialysis clearance, EACA half-life, and volume of distribution of EACA were calculated. Total body clearance of EACA was 26 ml/min, which is 25% of the drug clearance in patients with normal renal function. Our results suggest that patients undergoing peritoneal dialysis should receive 25% of the usual recommended dose of EACA. Dialysis clearance accounted for only 58% of total body clearance, suggesting an alternative route of elimination of EACA.
Noninvasive localization of brain-stem lesions in the cat with multimodality evoked potentials
Authors: Greenberg Richard P. , Stablein Donald M. , Becker Donald P.
Published: May 2009

✓ Multimodality evoked potential (MEP) data from over 300 comatose head-injured patients suggest that central nervous system dysfunction of the brain stem and/or hemispheres can be localized with this noninvasive neuroelectric technique. Based on this work, decerebrate motor posturing and prolonged coma are not associated with brain-stem dysfunction but rather with dysfunction of the hemispheres, while absent pupillary and oculocephalic responses are correlated with brain-stem dysfunction alone. However, the accuracy with which MEP data localized human brain-stem or hemispheric dysfunction could not be confirmed by pathological correlation because of low mortality and the small number of autopsies obtained in the patients who died. Therefore, this study was undertaken in an animal model of brain-stem lesion.

Complete brain-stem transections were made at the cervicomedullary junction, the medulla just caudal to the eighth nerve, and at the intercollicular region. All cortical visual evoked potential (VEP) peaks were reduced in amplitude and delayed by each of the brain-stem transections, but none of the peaks was abolished. In spite of brain-stem transection, VEP's can be used to gain information about hemispheric function. Somatosensory (SEP) and auditory cortically generated evoked potentials (AEP) were abolished by these brain-stem transections, but early-latency brain-stem SEP and AEP data could accurately localize specific areas of brain-stem dysfunction caused by the lesions. Observations made on human MEP data seem to be confirmed by these animal experiments. Correlations between human and cat MEP data are discussed.
Improved confidence of outcome prediction in severe head injury
Authors: Narayan Raj K. , Greenberg Richard P. , Miller J. Douglas , Enas Gregory G. , Choi Sung C. , Kishore Pulla R. S. , Selhorst John B. , Lutz Harry A. , Becker Donald P.
Published: May 2009

✓ An analysis of clinical signs, singly or in combination, multimodality evoked potentials (MEP's), computerized tomography scans, and intracranial pressure (ICP) data was undertaken prospectively in 133 severely head-injured patients to ascertain the accuracy, reliability, and relative value of these indicants individually, or in various combinations, in predicting one of two categories of outcome. Erroneous predictions, either falsely optimistic (FO) or falsely pessimistic (FP), were analyzed to gain pathophysiological insights into the disease process. Falsely optimistic predictions occurred because of unpredictable complications, whereas FP predictions were due to intrinsic weakness of the indicants as prognosticators.

A combination of clinical data, including age, Glasgow Coma Scale (GCS) score, pupillary response, presence of surgical mass lesions, extraocular motility, and motor posturing predicted outcome with 82% accuracy, 43% with over 90% confidence. Nine percent of predictions were FO and 9% FP. The GCS score alone was accurate in 80% of predictions, but at a lower level of confidence (25% at the over-90% level), with 7% FO and 13% FP. Computerized tomography and ICP data in isolation proved to be poor prognostic indicants. When combined individually with clinical data, however, they increased the number of predictions made with over 90% confidence to 52% and 55%, respectively. Data from MEP's represented the most accurate single prognostic indicant, with 91% correct predictions, 25% at the over-90% confidence level. There were no FP errors associated with this indicant. Supplementation of the clinical examination with MEP data yielded optimal prognostic power, an 89% accuracy rate, with 64% over the 90% confidence level and only 4% FP errors.

The clinical examination remains the strongest basis for prognosticating outcome in severe head injury, but additional studies enhance the reliability of such predictions.
Diagnostic and therapeutic alternatives in patients with symptomatic “carotid occlusion” referred for extracranial-intracranial bypass surgery
Authors: Heros Roberto C. , Sekhar Laligam N.
Published: May 2009

✓ An increasing number of patients with symptomatic carotid artery occlusion are being referred for extracranial to intracranial bypass grafts. After careful clinical and angiographic assessment, a number of these patients have been treated with a direct approach to the carotid arteries in the neck or with anticoagulation rather than with a bypass graft. These patients may be categorized diagnostically under the following headings: 1) complete occlusion of the internal carotid artery (ICA) with intracranial patency; 2) spontaneous dissection of the ICA; 3) atheromatous pseudo-occlusion; 4) carotid artery occlusion with stenosis of the contralateral ICA; 5) occlusion of the ICA and stenosis of the external carotid artery; and 6) thrombus in the intracranial segment of an occluded ICA. Each of these categories is discussed briefly, and illustrative cases are presented.
Spontaneous reversal of internal carotid artery occlusion
Authors: Cusick Joseph F. , Daniels David
Published: May 2009

✓ Spontaneous dissection of the internal carotid arteries, including those dissections resulting in total occlusion, may be a spontaneously reversible process. A patient who had angiographic evidence of bilateral complete internal carotid artery occlusions of different ages of onset illustrates this process. This case suggests certain considerations regarding the pathogenesis of these dissections.
Hydrosyringomyelia of the conus medullaris associated with a thoracic meningioma
Authors: Blaylock Russell L.
Published: May 2009

✓ The case of a 73-year-old woman found to have hydrosyringomyelia associated with a lower thoracic meningioma is reported. Possible mechanisms for the formation of the hydrosyrinx are discussed, with particular attention being paid to the possibility of transmural passage of cerebrospinal fluid into the central canal.
Evaluation of CCNU, VM-26 plus CCNU, and procarbazine in supratentorial brain gliomas
Authors: _ _
Published: May 2009

✓ This prospective and randomized trial reports the effects of three chemotherapeutic regimens on three different clinical parameters in adults with supratentorial malignant brain gliomas: 1) duration of the interval between surgery and relapse (the “free interval”); 2) total survival time; and 3) rate and length of objective remissions. All patients were irradiated with 5500 to 6000 rads after neurosurgery aimed at an optimum removal.

The administration of VM-26, 60 mg/sq m on Day 1, plus CCNU, 130 mg/sq m on Day 2, repeated every 6 weeks, had no significant effect on the length of the free interval between surgery and relapse. Thus, the median duration of this period was 39 weeks in the group of 61 patients who received adjuvant chemotherapy and 30 weeks in 55 controls without treatment. Neither was the total survival time prolonged by the administration of early chemotherapy. The best prognostic factor for the duration of the free interval and survival was age: patients under 50 years old survived statistically significantly longer.

The rate of the objective remission, defined as a clear-cut clinical improvement persisting 6 weeks after complete discontinuation of steroids, was measured after tumor relapse. In patients who were not previously treated with chemotherapy, CCNU alone or VM-26 plus CCNU produced objective remissions in only 15% of treated patients. Out of 17 cases treated previously by VM-26 plus CCNU, none responded to procarbazine after relapse.
Efficacy of continuous treatment with radiation in a rat brain-tumor model
Authors: Wheeler Kenneth T. , Kaufman Kenneth
Published: May 2009

✓ Rats bearing intracerebral 9L/Ro tumors were treated with 10 daily fractions of cesium-137 γ-rays, BCNU, or combinations of these two agents beginning on either Day 10 or Day 12 after implantation. The treatments were administered either 5 days/week for 2 weeks, with the weekend off, or 10 consecutive days. The median day of death for untreated tumor-bearing rats was Day 15, so Day 12 tumors can be considered late tumors and Day 10 tumors can be considered moderately early. Although all single- and multiple-agent treatments significantly (p < 0.05) increased the lifespan of tumor-bearing rats over that of the untreated controls, and all multiple-agent schedules significantly (p < 0.05) increased the lifespan over that of the single-agent therapies, none of the 10 consecutive day schedules increased the lifespan of tumorbearing rats significantly (p > 0.2) over that obtained with the 5-day/week schedules. Thus, the evidence from this tumor model suggests that no significant improvement in lifespan would be expected if malignant brain tumors were treated with radiation 7 days a week, either alone or in combination with chemotherapeutic agents such as BCNU.
Dandy-Walker syndrome
Authors: Sawaya Raymond , McLaurin Robert L.
Published: May 2009

✓ A clinical analysis of 23 patients with Dandy-Walker malformation indicates that more than 85% of them were diagnosed at or before 1 year of age, and that the incidence of associated anomalies is approximately 50%, with a 17% incidence for agenesis of the corpus callosum. The significance of the presence of these anomalies is substantiated by the fact that of the seven deaths recorded, six were related to this disease and five were affected by associated anomalies. The high mortality rate (26%) is comparable to that of other series. The differential diagnosis with posterior fossa extra-axial cysts is discussed.

Ten patients were primarily treated with excision of the cyst membrane; all of them required subsequent shunting to control the intracranial pressure, demonstrating the futility of this approach. None of the patients treated with lateral ventricle shunting suffered an upward herniation of the posterior fossa contents, suggesting that combined shunting of the lateral and fourth ventricles is rarely necessary. The technical advantages of posterior fossa shunting alone are outlined. Of the 16 survivors, 14 were assessed for their mental development by means of standard psychometric testing. The results of the intelligence quotient (IQ) scoring have indicated that 71% of the patients have subnormal mental development (IQ < 83). There was no significant relationship between retardation and associated anomalies, although agenesis of the corpus callosum was related to poor intellectual development in the two patients so affected (IQ's of 50 and 73).
Shunt nephritis
Authors: Wyatt Robert J. , Walsh John W. , Holland Nancy H.
Published: May 2009

✓ Three cases of shunt nephritis in which serial complement levels were obtained during the course of treatment are presented to illustrate the value of monitoring complement levels in the management of this condition. In shunt nephritis, circulating immune complexes are formed which contain antigen from bacteria of low virulence. These complexes, which activate the classical complement pathway, are reflected in most cases by lowering of the serum levels of C1, C2, C4, and C3. These levels promptly return to normal after the initiation of effective therapy. Serial determinations of serum levels of complement protein provide a sensitive and reliable method for early determination of efficacy of therapy in shunt nephritis.
Late postoperative tension pneumatocele
Authors: Vaquero Jesús , Cabezudo José M.
Published: May 2009

✓ A subgaleal tension aerocele associated with an extracerebral air collection and rhinorrhea is reported. It occurred 3 months after removal of a frontal en plaque meningioma affecting the frontal sinus.
Hydrocephalus and infratentorial tumors
Authors: Raimondi Anthony J. , Tomita Tadanori
Published: May 2009

✓ One may consider that the child with hydrocephalus complicating a primary brain tumor has two distinctly different diseases: 1) a neoplasm, and 2) hydrocephalus. The hydrocephalus may be obstructive, communicating, or (in the case of choroid plexus papilloma) hypersecretory. This paper presents the incidence, symptomatology, and management of hydrocephalus associated with infratentorial brain tumors in 156 children and with pineal tumors in 21 children, all treated by the first author during the period 1967 to 1979. Medulloblastoma was the most commonly encountered tumor. Of 117 children with cerebellar-fourth ventricle tumors, 110 had hydrocephalus, whereas 11 of 34 with brain-stem tumors and all 21 with pineal tumors presented with hydrocephalus. Of the total 143 patients with hydrocephalus, shunts were inserted before craniotomy in 123, with the interval between shunt insertion and craniotomy for tumor removal ranging from 1 to 21 days. Eighteen of these children required shunt revisions after craniotomy; 36 of 80 patients followed for 6 months or more had their shunts permanently removed, but it was necessary to reinsert the shunt from 5 days to 13 months later in 30% of these patients. Only 25 patients remained permanently shunt-free. It is considered that the placement of shunts before craniotomy is justified by the extraordinarily high incidence of papilledema and visual impairment associated with hydrocephalus. “Upward herniation” and dissemination of neoplastic cells through the shunting system are theoretical contraindications to precraniotomy shunt insertion, although the former is rare (3%), and there is no statistical evidence to support the latter.
Significance of postshunt ventricular asymmetries
Authors: Linder Martin , Diehl Jan T. , Sklar Frederick H.
Published: May 2009

✓ Ventricular asymmetries after shunt surgery were studied. Right and left ventricular areas from pre and postoperative computerized tomography scans were measured with a computer digitizing technique, and the respective areas were expressed as a ratio. Measurements were made from the scans of 15 hydrocephalic children selected at random. Ages at surgery ranged from 2 weeks to 10.5 years. The time interval between surgery and the postoperative scan ranged from 1 to 101 weeks.

The results indicate a significantly greater decrease in ventricular size on the side of the ventricular shunt catheter. Multiple regression analysis showed no relationship between the magnitude of change in ventricular size and either the patients' ages or the time intervals between surgery and follow-up scans. Possible mechanisms for these postshunt ventricular asymmetries are discussed.
Radiofrequency neurolysis in a clinical model
Authors: Smith Harold P. , McWhorter Joe M. , Challa Venkata R.
Published: May 2009

✓ Reports differ on which nerve fibers are affected by radiofrequency lesions made in peripheral nerves, some stating that primarily the myelinated delta and unmyelinated C fibers are destroyed, others stating that the destruction affects all sizes of nerve fibers and both myelinated and unmyelinated fibers. This study was designed to confirm one of those two findings, and to study the role that different temperatures might play in determining which fibers are affected.

Radiofrequency lesions (85°C for 2 minutes) were made in dogs by placing a temperature-monitored electrode into the lumbar intervertebral foramina. The dogs were killed at intervals up to 6 weeks after rhizotomy, and the lesions were studied by light and electron microscopy. In all lesions, there was a total loss of unmyelinated fibers and a nearly total loss of myelinated fibers. In other dogs, 2-minute lesions were made at 45°, 55°, 65°, and 75°C, and the lesions examined 1 week later. Again, all sizes and all types of fibers were destroyed.
Lymphomatoid granulomatosis with multiple intracranial lesions
Authors: Simon Richard H. , Abeles Micha , Farber Neil J. , Grunnet Margaret , Brennan Thomas G.
Published: May 2009

✓ A case of lymphomatoid granulomatosis with multiple intracranial lesions is reported. Important aspects of this vasculitis are discussed, including its propensity for lymphomatous transformation, its similarity to Wegener's granulomatosis, its predilection for certain sites, and its resistance to treatment. A correlation is described between the computerized tomography scan and the autopsy findings.
Primary osteogenic sarcoma of the sellar region
Authors: Reichenthal Eli , Cohen Mathias L. , Manor Riri , Marshak Gideon , Matz Shoshana , Shalit Mordechai N.
Published: May 2009

✓ A case of primary osteogenic sarcoma of the sellar and parasellar region is described. A biopsy performed through the transnasal transsphenoidal approach appears to be the best method of establishing the diagnosis in lesions in this location. A previous case, documented in the German literature, is discussed together with the case presented here.
Adenosine-stimulated astroglial swelling in cat cerebral cortex in vivo with total inhibition by a non-diuretic acylaryloxyacid derivative
Authors: Bourke Robert S. , Waldman John B. , Kimelberg Harold K. , Barron Kevin D. , San Filippo Bruce D. , Popp A. John , Nelson Louis R.
Published: May 2009

✓ The intact cerebral cortices of cats were exposed in vivo under normothermic conditions and superfused with isotonic artificial cerebrospinal fluid containing added 0.125 mM adenosine. This resulted in chloridecation-rich cerebrocortical swelling which was shown by electron microscopy to be associated with an expanded astroglial compartment. The addition of DCPIB, a non-diuretic acylaryloxyacid analogue of ethacrynic acid and an inhibitor of coupled chloride-cation transport in cerebral cortex in vitro, totally blocked astroglial swelling and the concomitant increases in tissue ion contents. These studies support our previous experiments on the mechanism of formation of astroglial swelling. The pathological consequences of astroglial swelling and the clinical applications of these findings are discussed.
Primitive neuroectodermal tumors of childhood
Authors: Duffner Patricia K. , Cohen Michael E. , Heffner Reid R. , Freeman Arnold I.
Published: May 2009

✓ Primitive neuroectodermal tumors are found in the cerebrum of children and young adults. They are clinically highly malignant and have a rapid course from diagnosis to death. Their microscopic pathology reveals 90% to 95% nondifferentiation, frequent mitoses, and small dark cells with no observable cytoplasm. This paper discusses the treatment of three children with this tumor with a combination of surgery, irradiation, and combinaton chemotherapy. The results of this approach are compared with previous reports in the literature. The average survival in this series is 24 months versus approximately 8 months reported in the literature.
Barbiturate effects on acute experimental intracranial hypertension
Authors: Bricolo Albino P. , Glick Roberta P.
Published: May 2009

✓ Acute intracranial hypertension was induced in cats by progressive inflation of an epidural balloon. Changes in intracranial pressure (ICP), mean arterial pressure (MAP), cerebral perfusion pressure (CPP), heart rate (HR), electroencephalogram (EEG), and pupil size were studied in untreated animals and in animals that had received barbiturates at different stages during the experiment. In animals pretreated with barbiturates, the increase in ICP during balloon expansion was significantly less than in untreated animals (p < 0.001). The CPP, initially higher in untreated animals, was not significantly different (p < 0.05) as the mass lesion pressure-volume curve exceeded the inflection point. In the postdeflation period, the untreated animals developed a significant increase in ICP, whereas, in the barbiturate-pretreated group, the ICP returned to preinflation values, suggesting a protective effect of barbiturates against postcompression brain swelling. Barbiturates affected ICP and CPP differently in animals with intracranial hypertension due to the presence of an epidural balloon that was maintained inflated compared to those with postdeflation brain swelling. In the latter group, pentobarbital reduced ICP (p < 0.05) without significantly decreasing the CPP, whereas, in the mass lesion group, barbiturates failed to reduce the ICP and caused a deterioration in CPP (p < 0.025). Brain gross pathological changes were significantly less in the pretreated animals as compared with all other groups. The results suggest that if barbiturate treatment is to have therapeutic value, the timing of the therapy and the criteria for its initiation should be determined.
Bilateral cavernous sinus metastasis and ophthalmoplegia
Authors: Mills Richard P. , Insalaco Sam J. , Joseph Allen
Published: May 2009

✓ A 59-year-old man developed bilateral total ophthalmoplegia with trigeminal hypesthesia immediately after the placement of burr holes for drainage of a subdural hematoma. Metastatic lung carcinoma to both cavernous sinuses was suspected, eventually proven, and confirmed postmortem.
Growing fracture of the skull and the role of computerized tomography
Authors: Lye Richard H. , Occleshaw J. V. , Dutton John
Published: May 2009

✓ Growing fracture of the skull is a rare complication following head injury. The case history of a child with such a fracture, who developed a leptomeningeal cyst, is presented. The unusual features of this case are discussed in the light of previous reports. The usefulness of computerized tomography in obviating the need for more invasive preoperative investigations is demonstrated.
Meningiomas associated with large cysts with neoplastic cells in the cyst walls
Authors: Bowen J. Hartley , Burger Peter C. , Odom Guy L. , Dubois Philip J. , Blue James M.
Published: May 2009

✓ Two adults presented with frontal lobe masses. As visualized by computerized tomography, both lesions were large cysts with contrast-enhancing mural nodules and enhancing circumferential rims. En bloc resections of the mural nodules and cyst walls were performed. Pathological evaluation of each nodule disclosed a meningioma, and neoplastic cells were found in the distant cyst walls. Although the walls of large cysts associated with some meningiomas have been composed of reactive glia or collagen, the neoplastic character of the cysts in the present cases underscores the need for resection and careful pathological evaluation of the large cysts associated with meningiomas.
Maffucci's syndrome complicated by an intracranial chondrosarcoma and a carotid body tumor
Authors: Armstrong Edward A. , McLennan James E. , Benton Corning , Chambers A. Alan , Perlman Aaron W. , Conners Jerry W.
Published: May 2009

✓ A patient with Maffucci's syndrome who had undergone multiple surgical procedures presented with blindness due to chondrosarcoma of the left sphenoid bone. A carotid body tumor was discovered, a coexistent tumor previously unreported in this syndrome.
Primary pineal choriocarcinoma with hemorrhage monitored by computerized tomography
Authors: Fujii Toru , Itakura Toru , Hayashi Seiji , Komai Norihiko , Nakamine Hirokazu , Saito Koji
Published: May 2009

✓ A case of primary pineal choriocarcinoma with acute onset of hemorrhage is reported in a young male. The patient received conservative therapy, including irradiation, on the basis of a suspected germinoma. Subsequent serial computerized tomography showed progressive hemorrhage in the primary pineal choriocarcinoma, which was confirmed at autopsy.
A successful approach to vertebrobasilar aneurysms
Authors: Litvak John , Sumners Thomas C. , Barron James L. , Fisher Larry S.
Published: May 2009

✓ The authors present a surgical technique for approaching vertebrobasilar area aneursysm. The dural and clival defect is obliterated by means of a live vascularized muscle flap. A regimen of antimicrobial prophylaxis is described.