bluuebunny/crossref_metadata_2025 huggingface dataset:
Selective spinal cordectomy: clinicopathological correlation
Authors: Durward Quentin J. , Rice George P. , Ball Melvyn J. , Gilbert Joseph J. , Kaufmann John C. E.
Published: May 2009

✓ The operation of selective spinal cordectomy is rarely performed. The cases of 10 paraplegic patients who underwent this procedure are presented. Their clinical indications were varied, including posttraumatic syringomyelia, uncontrollable leg spasticity, posttraumatic spontaneous neurogenic leg pain, and repair of a myelomeningocele gibbus. The cordectomy specimen was available for pathological examination in nine cases. Specimens removed from or near the site of spinal cord trauma showed extensive gliosis, leptomeningeal fibrosis, and schwannosis. This latter feature possibly represents an attempt at spinal cord repair by the dorsal root ganglion cells. Four specimens contained a syrinx with features including a thick gliotic wall and enlarged Virchow-Robin spaces, features that have been implicated in the pathogenesis of posttraumatic syringomyelia. Clinical results in the patients with syringomyelia and uncontrollable leg spasticity have been excellent. Cordectomy did not provide permanent relief in the patients with neurogenic leg pain. The authors conclude that selective spinal cordectomy is a valuable procedure for specific indications.
Definitive radiation therapy for chordoma and chondrosarcoma of base of skull and cervical spine
Authors: Suit Herman D. , Goitein Michael , Munzenrider John , Verhey Lynn , Davis Kenneth R. , Koehler Andreas , Linggood Rita , Ojemann Robert G.
Published: May 2009

✓ Proton-beam radiation therapy has been developed for the treatment of chordomas or sarcomas of bone or soft tissue that abut the central nervous system. The authors report the results of treatment of 10 patients, six with chordoma, three with chondrosarcoma, and one with a neurofibrosarcoma. Local control has been achieved for all patients (with, however, one marginal failure) with a follow-up period ranging from 2 months to 6 years. High doses of radiation, up to 76 Cobalt Gray Equivalents (CGE), have been delivered without significant morbidity. In particular, no neurological sequelae have been observed.
Liquid crystal thermography of the spine and extremities
Authors: Pochaczevsky Rubem , Wexler Charles E. , Meyers Phillip H. , Epstein Joseph A. , Marc Joseph A.
Published: May 2009

✓ Cholesteric liquid crystals are special compounds that display specific color changes in response to variations in temperature. Their responses can be graphically demonstrated by means of color thermography. A new color contact thermographic technique is described utilizing liquid crystals embedded in elastic flexible sheaths. These sheaths, when inflated, conform to the varied contours of the torso and extremities and, therefore, the new thermographic technique is especially well suited to the study of the skin dermatomes and myotomes. Typical heat patterns have been observed in root compression syndromes and particularly at the S-1, L-5, L-4, C-6, C-7, and C-8 levels. A high degree of anatomic accuracy can thus be achieved, comparable to or better than can be achieved by electromyography or myelography. Liquid crystal thermography can serve to screen patients for myelography and can complement myelography in identifying clinically significant abnormalities. The imaging technique correlates well with clinical and surgical findings, and constitutes one of the first attempts by means of a concomitant study of the body dermatomes to objectively document the subjective complaint of pain.
Complications of detachable balloon catheter technique in the treatment of traumatic intracranial arteriovenous fistulas
Authors: Barrow Daniel L. , Fleischer Alan S. , Hoffman James C.
Published: May 2009

✓ As carotid-cavernous sinus fistulas (CCSF) are not life-threatening, therapeutic attempts should carry a very low morbidity and mortality. The authors believe that utilization of detachable balloons is the treatment of choice for CCSF, although this procedure is not without risk. Seven patients have been treated for high-flow traumatic intracranial fistulas over the past 2 years with detachable balloons using a coaxial catheter system. This paper presents several complications that have been encountered during this experience, and advances suggestions regarding treatment and avoidance of potential complications.
Spontaneous germinal matrix and intraventricular hemorrhage in prematurely born rabbits
Authors: Lorenzo Antonio V. , Welch Keasley , Conner Scott
Published: May 2009

✓ Spontaneous hemorrhage into the ventricles in premature babies is a major problem, and neither its cause nor its pathogenesis is understood. A model is presented for the study of germinal matrix and intraventricular hemorrhage in the preterm rabbit. This animal is particularly suitable because like the human, 1) the maximal growth of the brain occurs perinatally; 2) there is an abundant germinal matrix near term, and by birth this is substantially reduced; 3) there is no rete mirabile; 4) the blood flow to the brain is via internal carotid and vertebral arteries; 5) the maturation of the lungs is completed just before term; and 6) the rabbit pup can maintain a separate existence from the dam when delivered prematurely. Eight of 64 such animals were found to have developed spontaneous germinal matrix hemorrhage with or without rupture into the ventricles. Several physiological and chemical features characteristic of the premature rabbit are presented. The hemorrhage in the lagomorph might be a paradigm of that in infants, and its study may aid in the understanding of the pathogenesis of the process.
Malfunctioning ventriculoperitoneal shunts
Authors: Sekhar Laligam N. , Moossy John , Norman Guthkelch A.
Published: May 2009

✓ The authors report the clinical and pathological findings in 201 procedures to revise malfunctioning ventriculoperitoneal shunts in 114 patients. The revised shunts were predominantly Raimondi three-piece systems. Collection of fluid along the shunt track is emphasized as an early clinical feature of shunt malfunction. In some cases, there are few clinical signs of shunt infection, and the first indication of it may be shunt malfunction. Ventricular catheter obstruction was caused by tissue from the region in addition to choroid plexus. Inflammation was frequently found around both ventricular and peritoneal catheters. Foreign bodies (cotton fibers, hair, and talc) and granulomatous inflammation were often present at both ends. Tissues obstructing the peritoneal catheter included embolic neoplastic cells, choroid plexus, and leptomeninges. There was also more necrotic debris at the peritoneal end. To prevent shunt malfunction, attention should be directed to: 1) optimal placement of ventricular catheters inside the lateral ventricle; 2) prevention of infection; 3) avoidance of contamination by cotton fibers, hair, or talc; and 4) improvements in the biocompatibility of the implanted materials.
Sudden hemorrhage in an acoustic neuroma
Authors: Castillo Reynaldo , Watts Clark , Pulliam Morris
Published: May 2009

✓ The authors present a case of acoustic neuroma associated with spontaneous hemorrhage. The sudden onset of new symptoms was noted and appears to be common to all such cases. The computerized tomography appearance of the mass underwent changes consistent with the clinical, surgical, and pathological findings.
Atypical trigeminal neuralgia in a 6-year-old boy
Authors: Roski Richard A. , Horwitz Samuel J. , Spetzler Robert F.
Published: May 2009

✓ This boy first contracted atypical trigeminal neuralgia at the age of 6 years. Four years later, he underwent a microvascular decompression of a venous loop from his trigeminal nerve. He remains asymptomatic 2 years after surgery.
Tuberculoma masquerading as a meningioma
Authors: Elisevich Konstantin , Arpin E. Joy
Published: May 2009

✓ Intracranial tuberculomas may imitate, both clinically and radiologically, the more commonly observed intracranial tumors. This case report outlines the development of such a lesion masquerading as a typical meningioma of the frontal fossa. Discussion of intracranial tuberculomas follows, with special reference to clinical and radiological findings.
Energy-requiring cell functions in the ischemic brain
Authors: Astrup Jens
Published: May 2009

✓ The energy-requiring cell functions in the brain are described. The role of specific inhibition of these functions, and their critical low-supply levels of blood flow and oxygen are reviewed in relation to clinical management of focal and complete global cerebral ischemia.
Skull growth after coronal suturectomy, periostectomy, and dural transection
Authors: Babler William J. , Persing John A. , Persson K. Maurits , Winn H. Richard , Jane John A. , Rodeheaver George T.
Published: May 2009

✓ Using radiocephalometric procedures, the authors examined the separate effects of suturectomy, periostectomy, and dural transection on the growing skull in young rabbits. When the coronal suture was surgically removed during normal growth, the freed frontal and parietal bones separated at a significantly accelerated rate. No accelerated separation was found when only the overlying periosteum and aponeurosis were transected. Furthermore, no additional separation was observed when the dura mater and falx cerebri were transected following suturectomy. Analysis of growth at the adjacent frontonasal and anterior lambdoid sutures suggested that the accelerated separation of bones after suturectomy was compensated for by reduced growth at these adjacent sutures. The result of these compensatory actions was that the total length of the skull remained unchanged. This study not only supports earlier observations that sutures grow in response to extrinsic separative forces but, significantly, that the suture tissue itself, rather than the dura or pericranium, acts as a restraint during normal translatory growth.
Cerebral dissecting aneurysm and intimal fibroelastic thickening of cerebral arteries
Authors: Mizutani Tomohiko , Goldberg Herbert I. , Parr Justin , Harper Clive , Thompson Carson J.
Published: May 2009

✓ A 19-year-old white man developed aphasia and right hemiplegia after several falls while waterskiing. Cerebral angiography displayed a ripple appearance and a “string of beads” sign along the left middle cerebral artery, with occlusion or stenosis of most of its branches. The patient died after 6 days, of transtentorial herniation due to massive left cerebral infarction. At necropsy, the infarct was found to be due to a subintimal dissecting aneurysm of the left middle cerebral artery. Multifocal areas of intimal fibroelastic thickening (IFT) were found not only at the site of dissection, but also in the other cerebral arteries, most prominent at the bifurcations of the vessels.

A systematic study of cerebral arteries performed in six control cases revealed that IFT was present in a similar distribution to that seen in the patient described. However, the degree of IFT in this patient was greater than in the controls. Some individuals with excessive IFT may be more susceptible to cerebral dissecting aneurysm under a variety of stresses, especially trauma.
End-to-end anastomosis of the anterior cerebral artery after excision of a giant aneurysm
Authors: Smith Robert R. , Parent Andrew D.
Published: May 2009

✓ A case of a giant anterior cerebral artery fusiform aneurysm is presented. The lesion was treated by primary excision of the involved segment with an end-to-end anastomosis of the proximal-distal segments of the anterior cerebral artery. It is believed that this technique has not been reported previously for lesions involving major intracranial arteries.
Embolization of cerebral arteriovenous malformations with bucrylate
Authors: Debrun Gérard , Vinuela Fernando , Fox Allan , Drake Charles G.
Published: May 2009

✓ Forty-six patients with cerebral arteriovenous malformations (AVM's) were selected for embolization with bucrylate. These patients were assigned to three different groups. Group I consisted of 22 patients with nonresectable AVM's who were selected for embolization with a Silastic calibrated-leak balloon. In 16 of these patients, embolization was achieved, with partial obliteration of the AVM in 14 and complete obliteration in two. Five patients had subarachnoid hemorrhage caused by the balloon bursting and concomitant dissection of the feeding vessel. Four of these patients recovered completely and one died of a brain-stem hemorrhage. A permanent field defect was noted in five cases, and two patients had a transient mild neurological deficit. Group II consisted of 13 patients treated by intraoperative embolization. Complete obliteration by embolization was obtained in four cases, and complete surgical resection after embolization in five. Partial embolization with no surgical resection was achieved in five cases. Three of these patients had a permanent mild neurological deficit and two had transient deficits. There was no mortality in this group. Group III consisted of 11 patients treated by embolization with bucrylate using a new latex calibrated-leak balloon. This balloon has a higher malleability, and takes on the exact configuration of the feeder, with no risk of dissection. This balloon also permits delivery of a faster and larger injection of bucrylate to the arterial feeders of the AVM. Two AVM's were completely obliterated, and embolization was only partially successful in the other cases. Neurological complications consisted of incomplete field defects in two cases, slight memory loss in one case, and transient clumsiness of the arm and face in one case. Two patients have a catheter permanently glued in the malformation, with no neurological complication. There was no mortality in this group.
Transsphenoidal microsurgical removal of growth hormone-secreting pituitary adenomas
Authors: Baskin David S. , Boggan James E. , Wilson Charles B.
Published: May 2009

✓ A series of 137 patients with growth hormone (GH)-secreting pituitary adenomas were treated by transsphenoidal surgery during a 10-year period. Group A comprised patients for whom this surgery was the first therapeutic intervention, and Group B included those who underwent the surgery after previous therapeutic intervention. The results were analyzed considering preoperative and postoperative endocrinological, neurological, ophthalmological, and neuroradiological data. Remission was defined as clinical response and a normal postoperative GH level, and partial remission as clinical response and postoperative reduction of the GH level by more than 50%. Any other result was considered failure. The mean follow-up period was 37.1 months; follow-up review was achieved in all the patients.

Among the 102 patients in Group A, remission was achieved in 80 (78%) patients with transsphenoidal surgery alone, and in an additional 16 (16%) after postoperative irradiation (combined response rate, 94%). All failures and patients with partial remission had preoperative GH levels of more than 50 ng/ml and suprasellar extension of the tumor. There were no deaths; 8% of patients had minor surgical morbidity; 5% had new hypopituitarism postoperatively. Of patients subsequently irradiated, 71% developed hypopituitarism.

Among the 35 patients in Group B, remission was achieved in 26 (74%), partial remission was obtained in two (6%), and seven (20%) were considered treatment failures. There were no deaths, and the morbidity rate was 14%; 66% of patients had hypopituitarism postoperatively. Of the eight patients who had received prior irradiation only, seven (88%) went into remission. All failures and partial responders had preoperative GH levels greater than 40 ng/ml; 56% had suprasellar extension. These results confirm the efficacy of the transsphenoidal approach for the treatment of GH-secreting pituitary adenomas.
End-to-side vascular anastomosis: a study of technical considerations in the rat
Authors: Tsitsopoulos Philip , Malbouisson Ana Maria B. , Harrison Michael J. G.
Published: May 2009

✓ A study of technical problems in the performance of microvascular anastomosis has been carried out in the rat. A comparison of two types of suture material suggested that handling characteristics had a significant effect on the time taken to complete the anastomosis, and on the accuracy of apposition of the vessel walls. Technical difficulties encountered intraoperatively proved predictive of subsequent compromise of the lumen, shown angiographically and histologically. The optimum conditions are discussed, and it is argued that postoperative antithrombotic medication is indicated when technical problems are encountered.
Intracranial pressure: to monitor or not to monitor?
Authors: Narayan Raj K. , Kishore Pulla R. S. , Becker Donald P. , Ward John D. , Enas Gregory G. , Greenberg Richard P. , Da Silva A. Domingues , Lipper Maurice H. , Choi Sung C. , Mayhall C. Glen , Lutz Harry A. , Young Harold F.
Published: May 2009

✓ The authors have analyzed their experience with intracranial pressure (ICP) monitoring in 207 patients over a 4-year period. Patients with either high-density or low-density lesions on computerized tomography (CT) at admission had a high incidence (53% to 63%) of intracranial hypertension (ICP persistently over 20 mm Hg). In contrast, patients with normal CT scans at admission had a relatively low incidence of ICP elevation (13%). Among these patients, three features were found to be strongly associated with the development of intracranial hypertension: 1) age over 40 years; 2) systolic blood pressure under 90 mm Hg; and 3) motor posturing — unilateral or bilateral. When two or more of these features were noted at admission, the incidence of intracranial hypertension was 60%, as compared to 4% when only one, or none, of these features were present. Thus, the patients at high risk for developing intracranial hypertension after severe head injury are those with abnormal CT scans at admission, and those with normal CT scans who demonstrate two or more of the above-mentioned adverse features. Based on these criteria, only 16% of this series of patients with normal CT scans would have qualified for monitoring.

In addition to the three clinical features noted above, multimodality evoked potential (MEP) studies were also found to be strong predictors of ICP elevation in the normal CT scan group, with a 75% incidence of intracranial hypertension in patients with disseminated deficits. There was no statistically significant correlation between the Glasgow Coma Scale score, eye movements, pupillary reaction, hypoxia, or anemia at admission and subsequent ICP elevation in the group with normal CT scans.

In this series, an intraventricular catheter was used as the sole monitoring device in 91% of the cases. In the remaining 9%, subarachnoid screws were employed, either alone, or upon failure of the ventriculostomy. While no mortality was directly ascribed to the monitoring process, there was a 7.7% complication rate (infection 6.3% + hemorrhage 1.4%). Eighty-five percent of the infections occurred in patients who had been monitored for 5 days or more, while no infections were noted in those monitored for less than 3 days. Used judiciously, this technique can be valuable in the monitoring and treatment of the brain-injured patient.
Cerebrospinal fluid pulse waveform as an indicator of cerebral autoregulation
Authors: Portnoy Harold D. , Chopp Michael , Branch Craig , Shannon Michael B.
Published: May 2009

✓ Systems analysis of the systemic arterial (SAPW), cerebrospinal fluid (CSFPW), and sagittal sinus (SSPW) pulse waves was carried out in 13 dogs during hypercapnia (5% CO2), intracranial normotension (inhalation of 100% O2), and intracranial hypertension (inhalation of 100% O2 plus an intraventricular infusion). Power amplitude and phase spectra were determined for each wave, and the power amplitude and phase transfer functions calculated between the cerebrospinal fluid (CSF) pressure and systemic arterial pressures, and between the sagittal sinus pressure and CSF pressure. The study indicates that the CSFPW and SSPW were virtually identical when impedance between the cerebral veins and sagittal sinus was minimal, which argues that the CSF pulse was derived from the cerebral venous bed. During inhalation of 100% O2, transmission of the SAPW across the precapillary resistance vessels into the cerebral venous pulse (as represented by the CSFPW) was nonlinear, while transmission across the lateral lacunae into the sagittal sinus was linear. During intracranial hypertension, wave transmission across the precapillary resistance vessels was linear, and across the lateral lacunae was nonlinear. During hypercapnia, wave transmission across the precapillary resistance vessels and the lateral lacunae was linear. When the wave transmission was nonlinear, there was also suppression in transmission of the lower harmonics, particularly the fundamental frequency, and a more positive phase transfer function, suggesting an inertial effect or decrease in acceleration of the pulse. Conversion from a nonlinear to linear transmission across the precapillary resistance vessels is evidence of loss of vasomotor tone, and is accompanied by rounding of the CSFPW. A vascular model which encompasses the above data and is based on flow in collapsible tubes and changes in vasomotor tone is posited to explain control of pulsatile flow and pulse waveform changes in the cerebrovascular bed. The model helps to clarify the strong interrelationship between intracranial pressure, cerebral blood flow, and cerebral autoregulation.
Osmotic and osmotic-loop diuresis in brain surgery
Authors: Schettini Alfonso , Stahurski Bernard , Young Harold F.
Published: May 2009

✓ In 22 patients to be operated on for brain tumors or cerebral aneurysms, the effect of osmotic diuresis was compared with that of osmotic-loop diuresis on plasma and cerebrospinal fluid (CSF) electrolytes, and water and ion excretion. Mannitol or mannitol plus furosemide were used to reduce brain bulk. After treatment with thiopental and hyperventilation, patients received randomly a rapid infusion of mannitol (1.4 gm/kg), or mannitol (1.4 gm/kg) plus furosemide (0.3 mg/kg). Brain shrinkage was considerably greater and more consistent with mannitol plus furosemide than with mannitol alone. However, hyponatremia, hypokalemia, hypochloremia, and hyperosmolality were also more marked (p < 0.05) with mannitol plus furosemide than with mannitol. The rate of water and ion excretion was even more striking. At 30 minutes after absorption of mannitol alone, water excretion peaked at 17 ml/min, and gradually decreased to 3.8 ml/min 70 minutes later. With mannitol plus furosemide, during an identical time course, initial water excretion was 30 ml/min, followed by a further rise to 42 ml/min and then a decline to 17 ml/min. At peak diuresis after mannitol, Na+ and Cl− excretion averaged 0.57 and 0.62 mEq/min, respectively. This compares with mean values of 3.7 and 4.12 mEq/min for Na+ and Cl−, respectively, after mannitol plus furosemide. Although optimum brain shrinkage is achieved with osmotic-loop diuresis, the rapid electrolyte depletion (Na+ and Cl−) must be corrected to avoid altered sensorium during the patients' postoperative course.
Nonsurgical approach to congenital scalp and skull defects
Authors: Muakkassa Kamel F. , King Robert B. , Stark David B.
Published: May 2009

✓ The management of congenital scalp and skull defects, as generally advocated, is surgical. The authors report such a case that was treated conservatively. At her 3-year follow-up review, the patient's scalp and skull defects and other associated cutaneous defects were fully reconstituted. Such a nonoperative approach, while rarely reported, emphasizes the natural course that some of these lesions may follow. The literature on aplasia cutis congenita is briefly reviewed.
Intracranial subdural sarcoid granuloma
Authors: Healton Edward B. , Zito George , Chauhan Prem , Brust John C. M.
Published: May 2009

✓ A patient is reported in whom a subdural sarcoid granuloma caused symptoms of an intracranial mass lesion, and disappeared following steroid therapy. Twenty-three previous cases with large intracranial sarcoid granulomas have been documented, and a review of these 24 cases leads the authors to conclude that: 1) neither symptoms nor nonhistological diagnostic studies, including computerized tomography, differentiate sarcoid from cerebral neoplasms or other central nervous system granulomas; and 2) because sarcoid mass lesions frequently respond well to corticosteroid therapy, surgery should probably be reserved for cases in which there is diagnostic uncertainty, a need for emergency decompression, or lack of response to steroids.
Pudendal neuralgia due to solitary neurofibroma
Authors: Tognetti Francesco , Poppi Massimo , Gaist Giulio , Servadei Franco
Published: May 2009

✓ An unusual case of pudendal neuralgia due to a solitary neurofibroma of the perineal region is described. The authors outline the long clinical history. There was complete pain relief after removal of the lesion.
A coaxial catheter system for afterloading radioactive sources for the interstitial irradiation of brain tumors
Authors: Gutin Philip H. , Dormandy Ray H.
Published: May 2009

✓ A coaxial two-catheter system that facilitates accurate stereotaxic placement of radioactive sources for the interstitial irradiation of brain tumors is described.
Proton nuclear magnetic resonance studies on brain edema
Authors: Naruse Shoji , Horikawa Yoshiharu , Tanaka Chuzo , Hirakawa Kimiyoshi , Nishikawa Hiroyasu , Yoshizaki Kazuo
Published: May 2009

✓ The water in normal and edematous brain tissues of rats was studied by the pulse nuclear magnetic resonance (NMR) technique, measuring the longitudinal relaxation time (T1) and the transverse relaxation time (T2). In the normal brain, T1 and T2 were single components, both shorter than in pure water. Prolongation and separation of T2 into two components, one fast and one slow, were the characteristic findings in brain edema induced by both cold injury and triethyl tin (TET), although some differences between the two types of edema existed in the content of the lesion and in the degree of changes in T1 and T2 values. Quantitative analysis of T1 and T2 values in their time course relating to water content demonstrated that prolongation of T1 referred to the volume of increased water in tissues examined, and that the two phases of T2 reflected the distribution and the content of the edema fluid. From the analysis of the slow component of T2 versus water content during edema formation, it was demonstrated that the increase in edema fluid was steady, and its content was constant during formation of TET-induced edema. On the contrary, during the formation of cold-injury edema, water-rich edema fluid increased during the initial few hours, and protein-rich edema fluid increased thereafter. It was concluded that proton NMR relaxation time measurements may provide new understanding in the field of brain edema research.
Posterior circulation revascularization
Authors: Ausman James I. , Diaz Fernando G. , de los Reyes R. A. , Pak Hooshang , Patel Suresh , Mehta Bharat , Boulos Roushdy
Published: May 2009

✓ Eight patients were evaluated for severe vertebrobasilar insufficiency (VBI). There were five males and three females, with an average age of 60.2 years (range 42 to 67 years). Three were diabetic and five hypertensive, including two patients who had both diseases. Seven of the eight had ongoing episodes of VBI refractory to anticoagulant and/or antiplatelet agents. Symptoms included two or more of the following in all patients: dizziness, diplopia, hemiparesis, hemihypesthesia, perioral numbness, bilateral visual blurring, dysarthria, and ataxia. Angiography revealed severe atherosclerotic stenosis of the proximal or midsection of the basilar artery in all patients.

A 10-cm segment of the anterior or posterior division of the superficial temporal artery (STA) was anastomosed to a proximal segment of the superior cerebellar artery (SCA) through a right subtemporal approach. Seven of eight (87%) postoperative angiograms demonstrated patency as evidenced by filling of the SCA and, in most cases, of the basilar artery. Six of the eight patients were improved or asymptomatic after the operation, one was unchanged, and one died. The average follow-up period was 14 months, with a range of 4 to 23 months. Transient morbidity included temporal lobe swelling in four patients and a subdural hematoma in one. Anastomosis of the STA to the SCA is a feasible therapeutic option in the patient with VBI secondary to stenosis of the proximal or midsection of the basilar artery.
Implanted continuous epidural morphine infusion system
Authors: Harbaugh Robert E. , Coombs Dennis W. , Saunders Richard L. , Gaylor Michael , Pageau Mark
Published: May 2009

✓ A number of reports have shown that epidural or intrathecal administration of morphine provides pain relief. Since February, 1981, the authors have used an implantable pump and epidural catheter for continuous epidural morphine infusion in patients with chronic pain. This system has functioned well, without respiratory or infectious complications. Functional characteristics of the system, technique of implantation, and preliminary results in two patients treated by this method are presented.
Clinical applications of the pressure-volume index in treatment of pediatric head injuries
Authors: Shapiro Kenneth , Marmarou Anthony
Published: May 2009

✓ The pressure-volume index (PVI) technique of assessing neural axis pressure-volume relationships was used as an adjunct to managing 22 children with severe head injuries and a Glasgow Coma Scale score of 8 or less. Ventricular cannulation was used to continuously monitor intracranial pressure (ICP). Actual PVI was measured by bolus injection of fluid and compared with predicted values determined from head circumference and spinal axis length in each patient. In 55% of the children, ICP was below 20 mm Hg at initial monitoring. During the course of monitoring, 86% of the children had ICP's exceeding 20 mm Hg. Reduced PVI (less than 80% of predicted normal) proved to be an accurate indicator of impending intracranial hypertension. The PVI proved to be a useful test for assessing the response to therapies for lowering ICP. This study demonstrates that reduced neural axis compliance accompanies intracranial hypertension following severe head injury in children, and that treatment of reduced neural axis compliance may prevent refractory intracranial hypertension.
Reduction of regional cerebral blood flow during brain retraction pressure in the rat
Authors: Rosenørn Jarl , Diemer Nils H.
Published: May 2009

✓ The use of brain retractors in intracranial operations may lead to focal cerebral ischemia and thereby cause brain infarction. To estimate the risk of ischemic damages, the authors investigated the regional cerebral blood flow (rCBF) in rats by means of autoradiography with 14C-iodoantipyrine at different brain retractor pressures (BRP). A reduction in rCBF to between 10 and 75 ml/100 gm/min with 20 mm Hg of BRP for 30 minutes was found in brain cortex lying under the retractor (normal 55 to 150 ml/100 gm/min). With a BRP of 30 mm Hg for 30 minutes, rCBF was reduced to between 0 and 40 ml/100 gm/min, and with a BRP of 40 mm Hg for 15 minutes rCBF was 0 to 15 ml/100 gm/min. The rCBF in the basal ganglia remained unchanged. Even with a BRP of 20 mm Hg for 30 minutes, there seemed to be a risk of focal ischemic damage.
Frequency of toxoplasmosis in the appearance of congenital hydrocephalus
Authors: Martinović Joksim , Šibalić Desanka , Djordjević Momčilo , Stefanović Branko , Nagulić Mirjana
Published: May 2009

✓ Thirty-eight children with signs of hydrocephalus have been tested for toxoplasmosis. On the basis of clinical data, including roentgenographical and ophthalmological findings, and serological data (Sabin-Feldman and IgM-IFA tests), congenital toxoplasmosis was confirmed in 15 (39%) infants. The diagnosis was established by demonstration of the persistence of Toxoplasma antibodies. In 13 (34%) infants aged 1 to 3 months there was not enough serological data and these were placed in a group of cases with “suspected congenital toxoplasmosis.” Ten children with negative serology for toxoplasmosis and with hydrocephalus were considered not to be infected.
Intraventricular fetus-in-fetu
Authors: Afshar Farhad , King Thomas T. , Berry Colin L.
Published: May 2009

✓ The authors present a case of an intraventricular 14-cm fetus in a 6-week-old infant who presented with enlarging head size. The entire intracranial fetus, with recognizable limbs, trunk, head, and exomphalos, was removed totally from the lateral and third ventricles, with excellent recovery in the patient, who is now 18 months old. The cytogenetical and tissue histological studies are reported. The embryology, operative procedure, and pathology of this condition are discussed and the literature briefly reviewed.
Successful treatment of solitary thalamic abscess
Authors: Ercius Mark S. , Dempsey Robert , Chandler William F.
Published: May 2009

✓ The authors report a solitary thalamic abscess, resembling a malignant glioma, that was successfully treated with transcallosal drainage and antibiotic therapy. Serial computerized tomography was used to follow this rare abscess to resolution.
Facial nerve preservation in patients with large acoustic neuromas treated by a combined middle fossa transtentorial translabyrinthine approach
Authors: Tator Charles H. , Nedzelski Julian M.
Published: May 2009

✓ With large acoustic neuromas, the primary goal of surgery is safe total removal of the tumors, and the secondary goal is preservation of nearby neural structures, including the facial nerve. In a series of 15 consecutive patients with large cerebellopontine angle tumors, all of which were more than 2.5 cm in diameter, tumor excision was performed by a one-stage combined middle fossa-translabyrinthine approach. There were 13 acoustic neuromas, 10 of which were more than 4 cm in diameter, one petrous apex meningioma 4 cm in diameter, and one facial neuroma 3 cm in diameter. The tumors were totally removed in all 15 patients. The facial nerve was preserved in 12 of 13 evaluable patients. In the 14th patient the nerve had been transected in a previous suboccipital procedure with incomplete removal, and in the 15th patient the nerve was sutured following excision of a facial neuroma. Thus, the nerve was lost at surgery in only one patient.

This combined approach provided very clear visualization of the cerebellopontine angle, including the brain stem and the lower cranial nerves. It enabled identification of both the origin of the facial nerve at the brain stem and the lateral segment of the nerve in the internal auditory canal. Anterior extensions of tumor growing through the tentorial hiatus were easily removed. The results in these 15 patients show that this approach is excellent for total removal of large acoustic neuromas with preservation of the facial nerve. It is especially suitable for large tumors with anterior extensions.
Cystic meningiomas: a clinicoradiological study
Authors: Dell Stephen , Ganti S. Ramaiah , Steinberger Abe , McMurtry James
Published: May 2009

✓ A group of eight cystic meningiomas is considered, with particular reference to preoperative radiological evaluation. Computerized tomography (CT) scanning alone is inadequate for diagnosis, and the authors offer an assessment of the current methods for preoperative identification of cystic supratentorial tumors, while reviewing the multiple etiologies suggested for the CT appearance. No single process explains all the aspects of peri- or intratumoral cyst formation in meningiomas.
Decompression of the posterior trigeminal root in trigeminal neuralgia
Authors: Taarnhøj Palle
Published: May 2009

✓ The author presents a long-term follow-up report of his experience with decompression of the posterior trigeminal root in 350 cases. He has found that the suboccipital approach results in fewer recurrences of pain than the temporal approach.
Tethered cord syndrome in adults
Authors: Pang Dachling , Wilberger James E.
Published: May 2009

✓ Patients with tethered cord syndrome (TCS) rarely have symptomatic onset in adulthood. Twenty-three adult patients with TCS were studied with respect to the clinical, radiological, and pathological features of this syndrome. Specific circumstances involving either additional tugging of the already tight conus, narrowing of the spinal canal, or direct trauma to the back or buttocks precipitated symptomatic onset in 60% of patients. Diffuse and non-dermatomal leg pain, often referred to the anorectal region, was the most common presenting symptom. Progressive sensorimotor deficits in the lower extremities as well as bladder and bowel dysfunction were also common findings; but, unlike TCS in children, progressive foot and spinal deformities were not seen. As in TCS with onset in childhood, the most common tethering lesions were thickened filum, intradural lipoma, and fibrous adhesions. The degree of cord traction, rather than the type or distribution of the tethering lesions, probably determines the age of symptom onset: less severe traction remains asymptomatic in childhood but results in neurological dysfunction in later life due to repeated tugging of the conus during natural head and neck flexion, or when abnormal tension is aggravated by trauma or spondylotic canal stenosis. Metrizamide myelography revealed the diagnosis of tethered conus in most cases, but the addition of computerized tomographic imaging provided valuable structural details concerning the tethering lesion. The surgical outcome was gratifying in relation to pain and motor weakness but disappointing in the resolution of bowel and bladder dysfunction. Early diagnosis and adequate release of the tethered conus are the keys to successful management.
Prevention of cerebral vasospasm after SAH with a thromboxane synthetase inhibitor, OKY-1581
Authors: Sasaki Tomio , Wakai Susumu , Asano Takao , Takakura Kintomo , Sano Keiji
Published: May 2009

✓ The efficacy of thromboxane synthetase inhibitor in the prevention of cerebral vasospasm after subarachnoid hemorrhage (SAH) was evaluated in a prolonged experiment using dogs. Changes in the diameter of the basilar artery were followed by angiography, and morphological changes were studied by photomicroscopy and electron microscopy. As a thromboxane synthetase inhibitor, OKY-1581 (sodium-(E)-3-(4(-3-pyridylmethyl)phenyl)-2-methylacrylate)was used. Dogs received intravenous injections of 160 mg of OKY-1581 dissolved in 2 ml of physiological saline immediately after subarachnoid blood injection. Subsequently, the animals received continuous intravenous infusion of the drug at the rate of 4 gm/50 ml/24 hours until sacrifice 4 days after induction of SAH. Control dogs received subarachnoid blood injection without treatment with OKY-1581.

Angiographic examination revealed that the late spasm was almost completely abolished by the treatment with OKY-1581. Early spasm was also prevented, but the drug's effect was less prominent than it was on the late spasm. Morphological study revealed degenerative changes in the endothelium and myonecrotic changes in the tunica media following SAH in the basilar arteries of the treated as well as the untreated dogs. However, corrugation of the internal elastic lamina was almost completely absent in the treated dogs.

The above results indicate that a disproportionate synthesis of thromboxane A2 plays an important role in the evolution of chronic cerebral vasospasm following SAH, and that drugs such as OKY-1581 that selectively inhibit thromboxane synthetase might be useful in the prevention of vasospasm.
The determination of brain water content: microgravimetry versus drying-weighing method
Authors: Shigeno Taku , Brock Mario , Shigeno Shuku , Fritschka Emanuel , Cervós-Navarro Jorge
Published: May 2009

✓ The microgravimetric technique and the drying-weighing method for the determination of brain water content are analyzed and compared. A new method has been devised for the automatic production of the gradient column. For gravimetry, tissue samples weighing more than 30 mg have proven adequate for measurement. Specific gravity (SG) should be determined as early as 1 minute after tissue is inserted into the gradient column. Calculations of cerebral blood volume (CBV) from changes in SG of both brain tissue and intravascular perfusate have shown that the SG of brain tissue is considerably influenced by changes in CBV. This is because the SG of blood is higher than that of brain tissue, and may lead to a decrease of SG of about 0.002 in anemic cortex and of 0.001 in anemic white matter, which will simulate a false increase in tissue volume as water of 4% and 2%, respectively. This methodological error may be relevant when the early stages of ischemic brain edema development are studied. Water content of brain tissue can also be determined with acceptable accuracy by vacuum freeze-drying samples of brain tissue weighing about 100 mg. In contrast to cortex, white matter shows a wide range of individual and regional differences in water content. Thus, conclusions on the presence of brain edema drawn from tissue water determinations should always be subjected to cautious analysis and criticism.
Colloid cyst of the third ventricle
Authors: Leech Richard W. , Freeman Thomas , Johnson Robert
Published: May 2009

✓ Three colloid cysts of the third ventricle were examined by both transmission (TEM) and scanning electron microscopy (SEM). There was morphological diversity of the cyst surface on SEM, with ciliated and non-ciliated cells present. In some areas, the non-ciliated cells were more numerous and extended above the surface. Individual non-ciliated cells show a wrinkled cell surface and bleb-like structures. The TEM findings correlated well with SEM, revealing two cell types. The non-ciliated cells appeared to have both exocrine and apocrine activity. In ciliated cells, abnormal cilia were related to abnormal centrioles; also present were highly abnormal microvilli. The appearance of the surface was similar to a normal ventricular surface. By allowing a greater assessment of cell types and their distribution, SEM has added one additional dimension in the evaluation of colloid cysts and their possible derivation.
Computerized tomography and surgical treatment of femoral compression neuropathy
Authors: Tysvaer Alf T.
Published: May 2009

✓ Two cases of femoral nerve compression are described. In the first, a large hematoma developed in the iliacus muscle while the patient was receiving anticoagulation therapy. In the second, a small abscess developed in the iliacus muscle 4 days after a proximal gastric vagotomy. Both cases were diagnosed by computerized tomography.
The dynamics of neuronal dysfunction and recovery following severe head injury assessed with serial multimodality evoked potentials
Authors: Newlon Pauline G. , Greenberg Richard P. , Hyatt Marti S. , Enas Gregory G. , Becker Donald P.
Published: May 2009

✓ Serial studies of visual, auditory, and somatosensory evoked potentials (EP's) obtained from 139 severely head-injured patients up to 1 year after trauma were analyzed to ascertain whether or not EP's can be used to monitor neurological recovery or deterioration following secondary insults. The EP data were analyzed using a grading system of abnormality developed previously, and patients were grouped by the most severe EP abnormality found in any modality during an early study (mean Day 3). The findings showed differential recovery trends depending on the severity of EP abnormality obtained on the initial study and presence of secondary insult. If EP's were normal early after injury, they remained so for up to 1 year, and these patients did well clinically. The EP's that were absent did not improve, and the patients had poor outcomes. Secondary insults did not affect the EP's or the outcomes of patients in these two groups. When EP's that were initially mildly abnormal became normal or remained no worse than mildly abnormal, patients had favorable outcomes in spite of complications. In contrast, deterioration of EP's with secondary insult indicated poor patient outcome. Severe EP abnormalities which improved over time led to favorable outcomes. However, persistence or deterioration of severe abnormalities indicated a poor outcome. Changes in EP's over time were better indicators of outcome than the presence or absence of complications. The results suggest that EP's may be used to assess neural recovery and the consequences of secondary insults to the brain. Four case reports are included to exemplify results.
Beagle puppy model of intraventricular hemorrhage
Authors: Ment Laura R. , Stewart William B. , Duncan Charles C. , Lambrecht Richard
Published: May 2009

✓ Intraventricular hemorrhage (IVH) is a major neurological problem of the preterm infant and originates in the germinal matrix tissues of the developing brain. The newborn beagle pup has been demonstrated to provide an excellent model for this neonatal neuropathological condition. By the production of hemorrhagic hypotension followed by relative volume reexpansion, such hemorrhages can be produced in this animal. Carbon-14(14C)-iodoantipyrine was used for measuring the cerebral blood flow in this experimental model and demonstrated that, although the germinal matrix is a relatively low-flow area in the newborn beagle pup, the selective flow to this region increases significantly in animals with IVH.
Failure of a Heifetz aneurysm clip
Authors: Kossowsky Ram , Dujovny Manuel , Kossovsky Nir , Keravel Yves
Published: May 2009

✓ A 16-year-old girl died from an acute subarachnoid hemorrhage following the fracture of a blade of a Heifetz aneurysm clip. The clip was manufactured from 17-7PH steel, which on metallurgical testing was found to be highly sensitive to intergranular corrosion. The fracture mechanism was stress corrosion, brought on by the combination of a stress load, an electrolytic environment, and a susceptible steel.
Fenestrated clips for unusual aneurysms of the carotid artery
Authors: Sugita Kenichiro , Kobayashi Shigeaki , Kyoshima Kazuhiko , Nakagawa Fukuo
Published: May 2009

✓ Twenty-four different kinds of fenestrated clips are introduced for the obliteration of unusual aneurysms. The clips were used for eight aneurysms of the internal carotid artery and 10 aneurysms of the vertebral artery. All but one of the aneurysms were successfully obliterated. Recommendations are made concerning the actual use of the clips.