bluuebunny/crossref_metadata_2025 huggingface dataset:
Technical note: Flow Sheet for the Neurosurgical Intensive Care Unit
Authors: Clifton Guy L. , Grossman Robert G.
Published: May 2010

With the rapid expansion of knowledge and techniques for the care of critically ill patients, the organization and recording of data have become increasingly complex and increasingly important for patient care. A flow sheet for the Neurosurgical Intensive Care Unit has been developed in a series of pilot studies with input from general and cardiovascular surgeons and nurses specializing in critical care medicine.
Treatment of Ischemic Deficits from Vasospasm with Intravascular Volume Expansion and Induced Arterial Hypertension
Authors: Kassell Neal F. , Peerless Sydney J. , Durward Quentin J. , Beck David W. , Drake Charles G. , Adams Harold P.
Published: May 2010

In 58 patients with progressive neurological deterioration from angiographically confirmed cerebral vasospasm after spontaneous subarachnoid hemorrhage, arterial hypertension was induced in an attempt to improve their deficits. The most effective regimen consisted of intravascular volume expansion, blockade of the vagal depressor response, and the administration of antidiuretics and vasopressor agents. With this protocol, arterial blood pressure could be sustained at high levels for prolonged periods. Neurological deterioration was reversed in 47 patients, transiently in 4: permanent improvement occurred in 43. Complications experienced during therapy included pulmonary edema, dilutional hyponatremia, aneurysmal rebleeding, coagulopathy, hemothorax, and myocardial infarction. Elevating systemic arterial pressure in states of cerebrovascular insufficiency resulting from vasospasm is safe if meticulous attention is paid to physiological, biochemical, and hematological parameters, with the exception that it may be hazardous in the presence of an untreated ruptured or intact aneurysm. Intravascular volume expansion and induced hypertension are effective in reversing ischemic deficits from vasospasm provided that treatment commences before cerebral infarction and that adequate pressures are maintained for a sufficient period. The production of a hypervolemic state by the use of colloid and crystalloid infusion accompanied by atropine blockade of the vagal depressor response and blunting of the diuresis with vasopressin enables arterial pressure to be elevated for longer than 1 week.
Spontaneous Cerebrospinal Fluid Otorrhea in Association with a Congenital Defect of the Cochlear Aqueduct and Mondini Dysplasia
Authors: Park Tae Sung , Hoffman Harold J. , Humphreys Robin P. , Chuang Sylvester H.
Published: May 2010

Unrecognized spontaneous cerebrospinal fluid (CSF) otorrhea led to recurrent bacterial meningitis in three children. The underlying cause of the spontaneous CSF otorrhea was proved to be a congenital cystic dilatation of the cochlear aqueduct and Mondini dysplasia of the temporal bone. The CSF leak recurred in all patients after an initial surgical attempt to close the defects through a tympanotomy. A suboccipital approach was used successfully to obliterate the CSF fistulas in two children; a translabyrinthine approach was used in the other. A search of the literature revealed that Mondini dysplasia is a congenital anomaly that can commonly cause spontaneous CSF otorrhea in children. The authors discuss the management of this uncommon entity on the basis of a literature review and their own experience.
Intracranial Epidural Suppuration: The Occult Empyema
Authors: Davidson Robin I.
Published: May 2010

Four patients with intracranial epidural empyema are discussed, illustrating the variety of clinical presentations of this process. A review of the ear, nose, and throat and neurosurgical literature is provided. The common incidental clinical presentation of this lesion is emphasized. Its symptoms are overshadowed almost invariably by concomitant disease processes, which include acute sinusitis, osteomyelitis, subgaleal empyema, subdural empyema, and subcortical intrapa-renchymal abscess. The diagnosis and treatment of intracranial epidural empyema are still dependent upon a high index of clinical suspicion.
Closure of Myelorachischisis Defects with Reverse Latissimus Dorsi Myocutaneous Flaps
Authors: Clark Dorothy H. , Walsh John W. , Luce Edward A.
Published: May 2010

The closure of myelorachischisis defects has been difficult and at times complicated. Over the past 2 decades, the use of rotational advancement flaps has been increasingly popular, but can be attended by instances of skin ischemia and necrosis. The development of the myocutaneous and muscle flap concept has aided reconstructive surgery. Extensive experience with the useful latissimus dorsi flap with and without overlying skin has been obtained for the reconstruction of a variety of truncal defects. We describe the use of bilateral “reverse” latissimus dorsi muscle flaps based on the paraspinal perforators for the closure of myelorachischisis defects in two patients. Coverage was uneventful in both instances. A 2-year follow-up revealed no compromise of upper extremity function due to sacrifice of the latissimus dorsi muscles. We offer an approach to the problem of closure of large myelorachischisis defects: bilateral reverse latissimus dorsi muscle flaps and delayed skin coverage. This approach seems to offer a good muscle layer over the dural closure and to provide long-standing durable coverage without apparent compromise of upper extremity function.
Spontaneous Cerebellar Hematoma in Children: Report of Two Cases and Review of the Literature
Authors: Ammirati Mario , Tomita Tadanori
Published: May 2010

Two children with hydrocephalus due to a spontaneous intracerebellar hematoma secondary to blood dyscrasia were treated successfully with a ventriculoperitoneal shunt. They represent the first documented cases of spontaneous intracerebellar hemorrhage in children treated successfully without posterior fossa operation. The size of the hematoma. the severity of the hydrocephalus, and the patient's neurological and physical condition are important factors in choosing the mode of treatment.
Tension Pneumocephalus after Trans-sphenoidal Hypophysectomy: Case Report
Authors: Shields Christopher B. , Valdes-Rodriguez Antonio G.
Published: May 2010

Tension pneumocephalus may occur spontaneously or may complicate a compound basal skull fracture or a cranial operation. We report a unique case of tension pneumocephalus after trans-sphenoidal hypophysectomy that may have developed because of the presence of an external lumbar subarachnoid drain.
Neuroradiological Detection of Small and Intracanalicular Acoustic Tumors: An Emphasis on CO2 Contrast-enhanced Computed Tomographic Cisternography
Authors: Clark W. Craig , Acker James D. , Robertson Jon H. , Gardner Gale , Dusseau John J. , Moretz William
Published: May 2010

Seventy patients suspected clinically of having an acoustic tumor were evaluated using the computed tomographic (CT) scan as the initial neuroradiological procedure, followed by CO2 contrast CT cisternography in cases where the intravenous contrast-enhanced scan did not reveal any lesion. Forty-eight gas CT cisternograms revealed 10 small acoustic tumors, 2 of which were totally intracanalicular. The authors present a review of the basic CT anatomy of the temporal bone as it relates to acoustic tumors. Based upon the ease of performance of the procedure, the low postexamination morbidity, and the excellent diagnostic results, CO2 CT cisternography is recommended as the procedure of choice in the diagnosis of small and intracanalicular acoustic tumors.
Lumbar Discectomy through a Small Incision
Authors: Balagura Saul
Published: May 2010

Postsurgical discomfort after lumbar discectomy can be minimized substantially by following a paramedian approach to the disc through a small incision. Comparison of results after this procedure and after a microsurgical approach showed a similar benign postoperative course.
Pressure-mounted Cottonoids: Technical Note
Authors: Arbit Ehud
Published: May 2010

A newly designed cottonoid is fixed to the tip of the suction device by the negative pressure. It is especially useful during microsurgical procedures in areas crowded with neurovascular elements. The advantage of pressure-mounted cottonoids lies in the protection provided to the brain and neurovascular elements during suction, even in the face of high aspiration pressure, and in the simplicity of their use.
Dural Invasion by Hodgkin's Disease
Authors: Mansfield James B.
Published: May 2010

The author presents a unique case of dural as opposed to epidural, subdural, or intramedullary metastatic involvement of the cervical spinal cord by metastatic Hodgkin's disease.
Spinal Meningioma: An Unusual Radiological and Clinical Case
Authors: Fontana M. , Carapella C. M. , Caroli F. , Riccio A.
Published: May 2010

The authors report a case of extra-intradural meningioma with an unusual myelographic appearance and a long clinical history. Some interesting radiological and clinical aspects of the lesion and possible pathogenetic mechanisms causing the erosion of the L-2 vertebra are discussed.
High Grade Astrocytoma with Spontaneous Meningeal and Cranial Invasion
Authors: Tognetti Francesco , Piazza Giancarlo , Morrone Bernardino
Published: May 2010

Unusual features of a Grade IV cerebral astrocytoma (glioblastoma) are presented; infiltration of the dura mater and destruction of the overlying calvarium. The meningeal fibroblastic reaction and the blood supply recruitment of the tumor from the external carotid system are also described. The literature dealing with biologically “aggressive” tumors of the glial series displaying direct invasion of the cranial extraneural structures is summarized.
Changes of the Auditory System after Cerebellopontine Angle Manipulations
Authors: Sekiya Tetsuji , Iwabuchi Takashi , Andoh Akira , Kamata Shigeki
Published: May 2010

The current tendency in acoustic neuroma surgery to attempt the preservation of hearing function and the problem of accidental hearing loss caused by microsurgical neurovascular decompression operations for hemifacial spasm or trigeminal neuralgia prompted us to study the exact surgical vulnerability of the auditory system. The surgical procedures for operation on the cerebellopontine angle of dogs were carried out according to the sequence of the posterior fossa transmeatal operation for acoustic neuroma. The operation was tentatively divided into three stages: (a) craniectomy and dural opening, (b) cerebellar retraction, and (c) identification of the cochlear nerve in the unroofed internal auditory canal (IAC). The postoperative behavior of the auditory system was evaluated electrocochleographically (EcochG) and histologically. Overzealous retraction of the cerebellar hemisphere caused transient disturbance of the EcochG pattern. Mechanical stretching of both the cochlear nerve and the internal auditory artery may cause a disturbance in the synchronized discharge of the cochlear neurons. Various manipulations at the porus acusticus internus or the IAC (such as pinching the nerve with forceps or electrocoagulation) produced thoroughly distorted EcochG patterns. From the histological findings, the main causative factor for these labyrinthine damages was considered to be vascular insufficiency The current need for neurosurgical operations to preserve hearing is discussed in the light of these findings.
Carbon Dioxide Laser Vaporization of Brain Tumors
Authors: Gongbai Chen , Qiwu Xu
Published: May 2010

Since 1977, we have used a 170-W CO2 laser manufactured in Shanghai. In animal studies we found less temperature increase in neighboring cerebral tissue after laser vaporization (0.8°C) than after bipolar coagulation (1.4°C) or monopolar coagulation (8°C). Some factors affecting the reaction of cerebral tissue to CO2 laser irradiation are discussed. This laser was also used in 30 craniotomies: 20 for gliomas, 5 for meningiomas, 4 for metastases, and 1 for a vascular malformation. No obvious cerebral or systemic adverse effects were seen, but the length of follow-up is insufficient to demonstrate an increased survival rate.
Intraventricular Cysticercosis
Authors: Ignacio Madrazo N. , GarcÍa-RenterÍa José A. , Miguel Sandoval B. , López Vega Francisco J.
Published: May 2010

The authors review their experience with 21 cases of intraventricular cysticercosis, which corresponded to 28% of all cases of neurocysticercosis in their department during an 18-month period. The surgical approach depends on the cyst's location; one uses the transcortical microsurgical approach to reach the lateral ventricles, the transcortical or transcallosal approach to reach the 3rd ventricle, and direct exploration to reach the 4th ventricle. Cysticercus cysts should be removed because they may produce acute or chronic hydrocephalus and, if the parasite dies within the ventricles, it will generate an inflammatory reaction with local and generalized ventriculitis, which produces irreversible neurological damage.
Gastric Secretory and Mucosal Injury Response to Severe Head Trauma
Authors: Gudeman Steven K. , Wheeler C. B. , Miller Douglas J. , Halloran Gregg L. , Becker Donald P.
Published: May 2010

The problem of gastric secretory and mucosal injury response was evaluated in 19 patients who had suffered a severe head injury. Fifteen of 19 patients had some evidence of gastrointestinal hemorrhage. In 7 cases, this was marked. The mean volume of gastric secretions ranged from 36.4 ml/hour on Day 1 to 47.6 ml/hour on Day 6. The mean value of titratable acidity ranged from 3.4 meq/hour on Day 1 to 3.9 meq/hour on Day 6. Possible risk factors were analyzed as a means of predicting specific subgroups of severely injured patients who would be more prone to have gastrointestinal complications. During the first 6 days after injury, there was no significant association (correlation coefficient not significant at the 0.05 level of significance) of the presence of an intracranial mass lesion, elevated intracranial pressure, brain stem dysfunction or prior episodes of hypotension or hypoxia, sepsis, shock, or the requirement for pressor agents with elevated gastric acid output, mucosal erosion, or hemorrhage. Because no specific risk factor or factors could be identified, all severely braininjured patients should be on some form of therapy for the prevention of gastrointestinal complications.
Hydatid Cyst of the Posterior Fossa: Case Report
Authors: Villarejo F. , Blazquez M. G. , Arcas J. , Pascual-Castroviejo I. , Esteban F.
Published: May 2010

A new case of a posterior fossa hydatid cyst is reported. The frequency, symptoms, diagnosis, and treatment of these cysts are discussed.
Compressive Neuropathy as a Complication of Anticoagulant Therapy
Authors: Hoyt Thomas E. , Tiwari Rajendra , Kusske John A.
Published: May 2010

Three cases of compressive neuropathy after anticoagulant therapy are reported. The first known description of ulnar and radial nerve involvement in this syndrome is provided. A review of the literature along with a discussion of some of the clinical features, the diagnosis, and the management of this entity are presented.
Use of the Carbon Dioxide Laser for Acoustic Tumor Surgery
Authors: Robertson John H. , Clark Craig W. , Robertson James T. , Gardner Gale L. , Shea Coyle M.
Published: May 2010

The carbon dioxide laser has been used clinically in both otorhinolaryngology and neurological surgery for approximately 10 years. Only recently, however, have technical modifications allowed its use with the operating microscope, providing the increased precision and control necessary for intracranial surgery. This paper reports the authors' experience with the carbon dioxide laser in the removal of acoustic tumors, details the surgical technique involved, and describes the advantages that may accompany the use of the laser in the removal of these difficult lesions.
Supratentorial Capillary Hemangioblastoma Presenting with Fatal Spontaneous Intracerebral Hemorrhage
Authors: Adegbite Andrew B. , Rozdilsky Bohdan , Varughese George
Published: May 2010

Spontaneous intracerebral hemorrhage from a supratentorial capillary hemangioblastoma resulting in the death of a 26-year-old woman is reported. We suggest that the presence of glial fibrillary acidic protein containing stromal cells in the tumor tissue may serve as a point distinguishing hemangioblastoma from angioblastic meningioma.
Ewing's Sarcoma Arising Primarily in the Spinal Epidural Space: Fifth Case Report
Authors: Spaziante Renato , de Divitiis Enrico , Giamundo Arcangelo , Gambardella Arturo , Di Prisco Bartolo
Published: May 2010

Ewing's sarcoma is found exceptionally as a primary epidural tumor of the spine. Four cases have been described in the literature. We describe the fifth case: a 10-year-old boy who underwent operation followed by radiotherapy and chemotherapy. For 1 year he then had a complete remission with no local recurrence and his neurological condition was satisfactory, although metastases developed later. Comparison with the cases described previously shows all five to possess interesting features in common.
Subclavian Catheterization for the Placement of a Ventriculovenous Shunt
Authors: Lehman Ralph A.W. , Hart James C.
Published: May 2010

Repeated nonfunction of the distal end of a ventriculoperitoneal shunt led to an unsuccessful attempt to introduce the distal catheter into the vena cava through the jugular vein. Subclavian catheterization utilizing a cardiac pacemaker introducer set proved to be a simple and effective means of establishing a ventriculovenous shunt.
Disturbances of Cerebrospinal Fluid Circulation during the Acute Stage of Subarachnoid Hemorrhage
Authors: Dóczi Thomas , Nemessányi Zoltán , Szegváry Zsuzsa , Huszka Endre
Published: May 2010

Radioisotope cisternography was performed and the erythrocyte and hemoglobin contents of the cerebrospinal fluid (CSF) were determined within the first 4 days after subarachnoid hemorrhage in 42 patients. The clinical condition of the patients was related to the severity of the CSF circulation disturbances. Thirty-five patients had some degree of disturbance of CSF flow, and only 2 of the 42 patients had normal flow. In 5 cases the cisternograms were inconclusive. The severity of CSF circulation disturbances correlated well with clinical condition. No relationship was found between the number of erythrocytes in the CSF and the development of CSF circulation disturbances. The CSF erythrocyte content did not correlate with the clinical condition. It is suggested that flow disturbances of the CSF during the acute stage of subarachnoid hemorrhage might play an important role in the pathomechanism of the disease.
Congenital Subgaleal (Epidermoid) Inclusion Cyst of the Anterior Fontanel in a Mexican Female Child: Case Report
Authors: Garza-Mercado Román , Tamez-Montes Dagoberto
Published: May 2010

A 30-month-old Mexican girl with an inclusion subgaleal cyst located over the anterior fontanel is described. This is the first such case ever diagnosed at our institution and, we believe, the first reported from Mexico. Radical excision of the lesion was accomplished. The internal table of the skull was eroded, but no intracranial extension was noticed. As the cyst contained no hair follicles nor any sebaceous or sweat glands, it was histologically classified as an epidermoid cyst. This is another example of such a lesion in an infant of non-African descent.
Osteogenic Sarcoma of the Skull Complicating Paget's Disease: Case Report
Authors: Young Henry A. , Hardy David G. , Ashleigh Raymond
Published: May 2010

A case of osteogenic sarcoma of the skull in a patient with long-standing Paget's disease is reported. Osteogenic sarcoma arising within the skull is rare in Paget's disease, although the recent literature emphasizes that it is more common than was realized previously. Intraparenchymal brain invasion, which is rare and present usually only as a preterminal event, was found in this patient who presented initially with minimal neurological findings. Rapid neurological deterioration in this patient was due to macroscopic hemorrhage into tumor. Although microscopic hemorrhage is characteristic of this tumor, gross hemorrhage into osteosarcoma of the skull as a cause of sudden neurological deterioration has not been reported previously. Radical resection is the treatment of choice, although the prognosis for this tumor remains dismal.
Primary Bioccipital Reticulum Cell Sarcoma: A Case Report with Emphasis on Carbon Dioxide Laser Applicatio
Authors: Habibi Mehdi , Bernstein Ronald A. , Stone James , Oldershaw John , Rhee Hwaja L.
Published: May 2010

A case of bilateral occipital primary reticulum cell sarcoma of the brain is reported, and the literature concerning this rare and often confusing tumor is reviewed. Gross total CO2 laser ablation of this infiltrating tumor of the right visual cortex is compared to conventional excision of the left occipital tumor in the same patient. The uniqueness of this case and the role of the CO2 laser in the total excision of such malignant tumors are emphasized.
Prevention of Air Embolism with Positive End Expiratory Pressure
Authors: Voorhies Rand M. , Fraser Richard A. R. , Van Poznak Alan
Published: May 2010

Pulmonary air embolism is recognized as a possible complication of neurosurgical procedures performed with the patient in the sitting position. A variety of preventive and therapeutic modalities have been proposed in the literature. We have used a consistent regimen consisting of precordial Doppler monitoring, measurement of end expiratory CO2, the semireclining position, and positive end expiratory pressure (PEEP). A right atrial catheter was not used. This approach has given good results in 81 patients: there was significant air embolism in only 1 case (1.2%). We believe that PEEP is as important in the prevention as it is in the treatment of pulmonary air embolism. By flexibly adjusting the level of PEEP, one may recreate the hemodynamic equivalent of the prone position, thereby eliminating the risk of venous air embolism and simultaneously the need for right heart catheterization.
Intracranial Extension of Nasal Dermoids
Authors: McQuown Sherry A. , Smith James D. , Gallo Anthony E.
Published: May 2010

Nasal dermoid cysts with intracranial extension have been thought to be a rare entity. Seven new cases of nasal dermoid cyst with intracranial involvement were treated from 1975 through 1982 by combined otolaryngological-neurosurgical management. Preoperative radiological studies were helpful in predicting intracranial extension in only three cases. The extracranial lesion was resected by the otolaryngologist using surgical hemoclips to tag the dermoid remnant entering the cranium. These hemoclips were a helpful landmark for the neurosurgeon when resecting the intracranial extension through a bifrontal craniotomy approach. In four cases, the dermoid cyst entered the cranium through a persistent foramen cecum and lay within the falx in association with a bifid crista galli. We think that this entity is more common than was previously appreciated. Patients with a diagnosis of nasal dermoid should undergo polytomography or computed tomography of the glabellar area. Even when all x-ray studies are negative, neurosurgical preoperative evaluation and operative standby should be obtained before the otolaryngologist attempts the resection of a nasal dermoid cyst.
Vasospasm of the Vertebrobasilar System in Cases of Ruptured Intracranial Aneurysm
Authors: Chui Mario , Battista Arthur F. , Kricheff Irvin I.
Published: May 2010

The reported incidence of vasospasm in cases of ruptured vertebrobasilar (VB) aneurysm varies considerably. The classification into local and diffuse spasm may partially explain the discrepancy. In the present small series, we found that local spasm is more common than diffuse spasm, which is rare in cases of ruptured VB aneurysm when compared with ruptured supratentorial aneurysm. It is hoped that further work may help to explain this apparent difference between the anterior and the posterior circulation and may contribute to the understanding of vasospasm.
In Vitro Secretion of Adenoma and Anterior Lobe Cells in Two Typical Cases of Cushing's Disease
Authors: Lüdecke Dieter K. , Schabet Martin , Saeger Wolfgang
Published: May 2010

Fragments of adrenocorticotropic hormone (ACTH) cell adenomas and anterior lobes of two patients with Cushing's disease were obtained by transnasal operation. Both patients showed the typical clinical course, with postoperative ACTH deficit and all other pituitary functions intact. Equivalent specimens of tissue were investigated by immunocytology and in a superfusion system. The majority of adenoma cells were ACTH-positive, whereas ACTH-secreting cells of the anterior lobes were mostly inactive and were reduced in number. In vitro, adenomatous tissue showed high ACTH secretion into the superfusion medium, which was increased significantly after vasopressin application. Corticoid feedback was impaired. Anterior lobe cells exhibited a significant spontaneous ACTH secretion that was reduced by cortisol, but not stimulated by vasopressin. These results support the concept of an impaired corticoid feedback at the adenoma level in the presence of suppressed ACTH secretion of the para-adenomatous anterior lobe.
Orbital Floor Fracture: An Unusual Complication of Trans-septal Trans-sphenoidal Hypophysectomy
Authors: Newmark Harris , Kant Naval , Duerksen Roger , Pribram Henry W.
Published: May 2010

The authors report a fracture of the orbital floor that was caused by a speculum during trans-sphenoidal hypophysectomy. There were also fractures of the medial wall of the maxillary antrum and the frontal process of the maxilla. This unusual complication has not been described previously.
Ventricular Obstruction Secondary to Vascular Malformations
Authors: Hoi Sang U. , Kerber Charles
Published: May 2010

Enlarged veins in two vascular malformations blocked the cerebrospinal fluid outflow pathways, causing hydrocephalus. Both patients presented not with the usual clinical picture (hemorrhage, seizure, etc.), but with signs of increased intracranial pressure. Computed tomography and angiography were necessary to understand the pathophysiology. An arteriovenous malformation was responsible for the first patient's headache, and a venous varix was the causative lesion in the second patient. Hydrocephalus caused by a venous varix has not been reported before.
Dural Plasmacytoma
Authors: Pritchard Paul B. , Martinez Robert A. , Hungerford Douglas G. , Powers James M. , Perot Phanor L.
Published: May 2010

Dural plasmacytoma is an unusual form of myeloma. We describe a woman with plasmacytoma of the tentorium cerebelli that was managed successfully with surgical decompression and radiotherapy. Computed tomography, not previously reported in cases of dural plasmacytoma, was useful in her management. Another unique feature was the restoration of a normal immunoglobulin G content in the blood and cerebrospinal fluid after local treatment of the neoplasm. Two previously reported cases showed similar normalization of cerebrospinal fluid immunoglobulin G after local radiotherapy. Dural plasmacytoma presents a characteristic clinical syndrome. The typical patient is a woman (92% of the reported cases) in the 5th decade of life. Clinical findings reflect intracranial hypertension, often with focal neurological signs, consistent with the usual dural or tentorial origin of the tumor. Immunoglobulin abnormalities may be found in serum or cerebrospinal fluid. The prognosis is good after surgical decompression and local radiotherapy.
Chronic Disseminated Intravascular Coagulation and Metastatic Brain Tumor: A Case Report and Review of the Literature
Authors: Sawaya Raymond , Donlon Jerome A.
Published: May 2010

A patient who had a primary lung carcinoma in remission but had a solitary metastatic lesion to the cerebellum was referred to the neurosurgery service. He was noted to be thrombocytopenic, and further hemostatic evaluation revealed chronic disseminated intravascular coagulation. He was treated with heparin and platelet transfusions. Although the fibrinogen levels improved, the thrombocytopenia persisted. Four weeks after admission, repeat chest x-ray films and tomograms indicated progressing metastatic nodules. A review of the literature reveals a variety of hemostatic defects associated with tumor metastatic to the brain. This current case indicates the need for careful hemostatic evaluation in all patients with brain lesions.
Effects of Therapeutic Pentobarbital Coma on Multimodality Evoked Potentials Recorded from Severely Head-injured Patients
Authors: Newlon Pauline G. , Greenberg Richard P. , Enas Gregory G. , Becker Donald P.
Published: May 2010

We sought to determine whether pentobarbital (PB) coma compromises the use of evoked potentials (EPs) in the assessment of brain dysfunction and of the prognosis of severely head-injured patients. Therefore, the effects of therapeutic PB on somatosensory (SEPs, BSEPs), visual (VEPs), and auditory (BAEPs) evoked potentials recorded from 20 patients early after injury were analyzed. Seventeen head-injured patients served as controls. EP studies were obtained shortly after admission (Mean Day 2, PB present) and approximately 2 weeks after injury (Mean Day 15, PB absent). The mean serum level of PB in the treatment group was 1.9 mg/100 ml. The drug effect was assessed by comparisons between the PB and the control groups. Statistical analyses were based on differences observed between two studies in the same patient. Analyses of covariance (F tests) were performed on data from all modalities. Wave form complexity was minimally affected by the drug. Middle and long latency components of the SEP were depressed by PB, and latencies of BSEP peaks and the early components of the SEP were delayed. The amplitude of some VEP peaks was reduced by PB. The BAEP was not significantly altered. All of the observed effects of PB were determined to be due to the hypothermia exhibited by PB-treated patients (mean temperature, 36.1ºC), which was not seen in the control group (mean, 37.8ºC). It is concluded that, with appropriate interpretation, EPs can be used to monitor brain function in head-injured patients when PB therapy is used.
Relationship between Contrast Enhancement on Computed Tomography and Cerebral Vasospasm in Patients with Subarachnoid Hemorrhage
Authors: Tazawa Toshiaki , Mizukami Masahiro , Kawase Takeshi , Usami Takashi , Togashi Osamu , Hyodo Akio , Eguchi Takashi
Published: May 2010

To elucidate the relationship between abnormal enhancement of the cisterns on computed tomography and cerebral vasospasm, we performed a systematic and prospective study in 60 patients with ruptured cerebral aneurysms. There is a significant relationship between the findings of contrast-enhanced computed tomography (CECT) within Day 3 of rupture and cerebral vasospasm. Among 37 patients undergoing CECT between Day 0 and Day 3. 17 (46%) showed prominent increases in density in the region around the circle of Willis and its branches. In 13 of 17 cases (76%), severe vasospasm with motor paralysis occurred. In the remaining 4 cases (24%) with only slight or no cerebral vasospasm, the hematoma in the subarachnoid space was removed surgically by Day 3. In 19 of 20 cases without remarkable CECT, no severe cerebral vasospasm with motor paralysis occurred. There is no significant relationship between the CECT findings after Day 3 and cerebral vasospasm. The results indicate that the prominent increase in density in the region of the circle of Willis and its branches often observed on CECT within Day 3 of subarachnoid hemorrhage is useful for prediction of the occurrence of cerebral vasospasm and also provide information on the pathogenesis of cerebral vasospasm.
Experience with Brain Biopsy for Suspected Herpes Encephalitis: A Review of Forty Consecutive Cases
Authors: Morawetz Richard B. , Whitley Richard J. , Murphy Dennis M.
Published: May 2010

From January 1973 through July 1981, 40 patients underwent brain biopsy for suspected herpes simplex encephalitis at the University of Alabama Medical Center. Biopsy was performed as a component of experimental antiviral studies to ensure correct diagnosis. A tentative diagnosis was made on clinical grounds, and the site of biopsy was chosen on the basis of localizing neurological signs, the electroencephalogram, and/or computed tomographic (CT) scan abnormalities. Patients ranged in age from 15 months to 73 years, with a median age of 19 years. Thirty patients were male, and 10 were female. Brain tissue from 17 of the 40 patients grew herpes simplex virus in tissue culture. There was one biopsy-related complication, a wound dehiscence requiring secondary closure. In no case was death attributable to the brain biopsy procedure. The outlook in patients with proven herpes encephalitis worsened directly with both an increasing interval between the onset of symptoms and the initiation of antiviral therapy and the age of the patient. The presence of a CT scan abnormality before the initiation of therapy was associated with a very poor prognosis. Three patients not included in this series were referred for brain biopsy to rule out herpes simplex encephalitis, but were found to have bacterial infections. Two had subdural empyemas and the third had a brain abscess with overlying subdural empyema. Current technique calls for biopsy of the anterior portion of the inferior temporal gyrus on the affected side.
Prenatal Diagnosis of Occipital Encephalocele by Ultrasound Scanning
Authors: Weinstein Philip , Weinstein Louis , Dotters Deborah , Bedrick Alan , Anderson Carolyn
Published: May 2010

Fetal visualization in utero can be routinely accomplished using noninvasive ultrasound techniques that do not administer ionizing radiation. Image resolution with real time sonography is sufficient to demonstrate details of possible congenital central nervous system malformations before delivery. The case reported illustrates the advantages of advance warning in an infant with occipital meningoencephalocele for determining prognosis, planning delivery by cesarean section, and preparing for immediate neurosurgical repair.
Intrasellar Abscess after Transsphenoidal Pituitary Adenomectomy
Authors: Robinson Bernard
Published: May 2010

Intrasellar abscess is a rare disease that is difficult to diagnose preoperatively. Few neurosurgeons who operate by the transsphenoidal route are concerned with intrasellar abscess despite its high mortality rate. We describe a case of intrasellar abscess which, to our knowledge, is only the second diagnosed or suspected preoperatively. Most cases have been diagnosed unexpectedly at operation or autopsy. This case also is the first reported intrasellar abscess arising within an intrasellar graft used to seal the sella turcica after transsphenoidal pituitary adenomectomy. The clinical suspicion of infection proved more reliable than roentgenograms and laboratory studies in leading to the proper diagnosis and successful therapy.
Neurogenic Pulmonary Edema Associated with Ruptured Spinal Cord Arteriovenous Malformation
Authors: Lee Don S. , Kobrine Arthur
Published: May 2010

A case of neurogenic pulmonary edema (NPE) associated with a ruptured spinal cord arteriovenous malformation (AVM) is presented. The mechanisms involved in the development of NPE are discussed briefly. The possible role of preganglionic sympathetic fibers in the spinal cord in the etiology of NPE is suggested.
Management of Plasmacytomas of the Spine
Authors: Loftus Christopher M. , Michelsen Christopher B. , Rapoport Frederick , Antunes J. Lobo
Published: May 2010

Epidural plasmacytoma often reflects systemic myelomatous involvement and usually has a poor prognosis. The isolated spinal plasmacytoma, however, is a lesion with the potential for long term remission or even cure in some cases. We report six patients with isolated plasmacytoma of the low thoracic or lumbar region, all of whom presented with pain and minimal neurological deficits. Our approach to such cases included a complete medical work-up and radiographic definition of the lesion with a bone scan, a skeletal survey, myelography, computed tomography, and, in some instances, spinal angiography. All of these patients underwent laminectomy and spinal fusion with autologous bone and harrington rods. There was no morbidity associated with the procedure, which was designed to prevent possible collapse during subsequent radiotherapy or chemotherapy, with its attendant potential for neurological catastrophe. Several patients have developed systemic involvement necessitating chemotherapy, but in follow-up extending now to 4 years all patients remain ambulatory and pain-free. We are encouraged by the potential for symptomatic relief and neurological improvement of patients with isolated spinal plasmacytomas who are treated with an aggressive medical and surgical approach.
Lumboatrial Shunt: Case Report
Authors: Friedman Phillip , Gass H. Harvey
Published: May 2010

Hydrocephalus without ventriculomegaly and pseudotumor cerebri may present special problems in its treatment. Lumboperitoneal shunting, although frequently effective, is not successful in all cases. A lumbar subarachnoid to venous shunt is described as an alternative to lumboperitoneal shunting. A case illustrating its use is reported.
Teratoid Cyst of the Spinal Cord
Authors: Padovani Roberto , Tognetti Francesco , Laudadio Silvia , Manetto Valeria
Published: May 2010

The authors report a rare case of intramedullary teratoid cyst, in which an arteriovenous malformation of the spinal cord was first suspected. The controversial problem of the histogenesis of teratomas is reviewed. The authors stress the benign course of these lesions after operation, even when radical surgery cannot be performed.
Sacral Plexus Nerve Sheath Tumor: Case Report
Authors: Robertson Jon H. , Gropper Gary R. , Dalrymple Sharon , Acker James D. , McClellan George A.
Published: May 2010

A young woman with chronic sciatica was found to have an intrapelvic sacral plexus nerve sheath tumor. Computed tomography of the pelvis was used to delineate this unusual site of tumor development. The case report and a discussion of pelvic nerve sheath tumors are presented.
Cerebral Gangliogliomas during Childhood
Authors: Sutton Leslie N. , Packer Roger J. , Rorke Lucy B. , Bruce Derek A. , Schut Luis
Published: May 2010

We have reviewed our experience with gangliogliomas treated in the post-computed tomography (CT) era at the Children's Hospital of Philadelphia. Of 234 newly histologically verified neoplasms seen at our institution since 1975, 10 (4.3%) were gangliogliomas of the cerebral hemispheres. The presenting complaint was seizures in 9 of 10 patients. and in 8 the seizures were poorly controlled despite increasing doses of anticonvulsant medication. At the time of diagnosis, only 2 patients had a focal neurological deficit and none had signs or symptoms of increased intracranial pressure. Learning disability and behavioral disturbances were common in this group of children. The CT appearance of these lesions was characteristic: most appeared as a cerebrospinal fluid density area that was located peripherally and often indented the skull. There was little contrast enhancement, and a few were diagnosed initially as arachnoid or porencephalic cysts. Despite the CT appearance, all but 2 of the lesions were found to be solid at operation. In one patient, the lesion appeared as an enhancing lesion of the thalamus, and this patient died. Operation resulted in symptomatic improvement. Eight of 9 children are alive, with a follow-up of 1 to 80 months (median, 19.5 months), and are free of progressive disease. Five are seizure-free while receiving anticonvulsant therapy and an additional 3 have improved seizure control as a result of operation. Two of the 3 children with intellectual difficulties preoperatively have shown improvement on testing after operation, probably the result of improved seizure control. One patient developed a disseminating malignancy and died. It is concluded that worsening seizures in the pediatric age group should warrant CT examination and that ganglioglioma should be included in the differential diagnosis of low density areas on CT.
Role of Emergency Skull X-ray Films in the Evaluation of the Head-injured Patient: A Retrospective Study
Authors: Cooper Paul R. , Ho Victor
Published: May 2010

Hospital admission of the patient with apparently minor head injury with a normal level of consciousness is generally unnecessary. However, a certain number of these patients will deteriorate neurologically because of the development of a post-traumatic intracranial mass lesion. Skull roentgenograms are commonly obtained in these patients in a search for a linear skull fracture on the assumption that a skull fracture predisposes the patient to the development of an intracranial mass. To determine the utility of emergency skull x-ray films. we retrospectively reviewed the records of 207 patients with known traumatic intracranial masses. We specifically sought to determine the number of patients who were neurologically intact at the time of presentation, were admitted solely because of the presence of a skull fracture, and then went on to develop signs or symptoms of an intracranial mass lesion. Of the 207 patients, 119 patients had cerebral contusions. 89 had subdural hematomas, 50 had intracerebral hematomas, and 31 had epidural hematomas (some patients had two or more lesions). Seventy-six of the 207 patients (37%) had skull fractures. One hundred ninety-one of 207 patients (92%) had an abnormal level of consciousness at the time of presentation and would have been admitted regardless of their skull film findings. Of the 16 patients who were fully alert, 10 had normal skull x-ray films: all were admitted for focal neurological deficits, nausea and vomiting, amnesia, etc., but would have been discharged had the skull x-ray films been the only determinant for admission. Six of the 16 patients who were alert had skull fractures. All but 1 of these patients had systemic injuries, focal deficit, or other reasons for admission. Only 1 patient of the entire series was completely intact neurologically, had a skull fracture, was sent out, and returned having experienced neurological deterioration. This patient had an epidural hematoma and made a good recovery after operation. We conclude that skull roentgenograms performed to identify linear skull fractures in the head-injured patient are neither cost-effective nor useful in predicting deterioration from a mass lesion and should not be used for this purpose or as a determinant for hospital admission.
Twist Drill Craniostomy and Closed System Drainage of Chronic and Subacute Subdural Hematomas
Authors: Carlton Candace K. , Saunders Richard L.
Published: May 2010

Based on reports in the literature on the success and low morbidity of twist drill craniostomy (TDC) and closed system drainage (CSD) for chronic subdural hematomas, a prospective study was initiated in 1981 and included all symptomatic patients presenting with a history and clinical and computed tomographic (CT) findings consistent with subacute or chronic subdural hematoma. A total of nine patients were treated with TDC and CSD as the initial procedure. An asymptomatic or progressively improving patient with greater than 50% reduction in subdural size by repeat CT scan was set as the end point of therapy. There were no complications, all patients improved with drainage, and seven were cured by this method alone. The results are compared retrospectively to surgically treated patients, and an overall decrease in morbidity and length of hospitalization are noted. The technique and CT scan correlations are described, and the rationale for use of this method is discussed in terms of our current understanding of the pathophysiology and complications of the disease.
High Dose Fentanyl-Oxygen Anesthesia for Intracranial Mycotic Aneurysm Surgery: A Clinical Report
Authors: Shupak Robert C. , Rosenwasser Robert H. , Harp James R.
Published: May 2010

The resection of a mycotic aneurysm in a patient with concurrent cardiac valvular disease was carried out successfully using high dose fentanyl-oxygen anesthesia followed by immediate postoperative naloxone reversal. The technique and benefits of this type of anesthesia in neurosurgical procedures are discussed.
Meningioma of the Fourth Ventricle: A Case Report
Authors: Tsuboi Koji , Nose Tadao , Maki Yutaka
Published: May 2010

A rare case of meningioma located in the 4th ventricle is reported. The mass was successfully removed. The authors also review 14 reported cases of this type of tumor.
Modification of the Gouda Frame to Allow Stereotactic Biopsy of the Brain Using the GE 8800 Computed Tomographic Scanner
Authors: Gouda Kasim I. , Freidberg Stephen R. , Larsen Carl R. , Baker Richard A. , Silverman Mark L.
Published: May 2010

The Gouda stereotactic frame has been modified to interface with the GE 8800 scanner. The patient, attached to the frame, is scanned and then moved to the operating room for a stereotactic biopsy. This is a safe, accurate method of obtaining biopsy specimens of otherwise inaccessible tumors of the brain.
Cushing's Disease in Childhood: Benign Intracranial Hypertension after Trans-sphenoidal Adenomectomy
Authors: Weissman Mark N. , Page Larry K. , Bejar Raphael L.
Published: May 2010

A 7-year-old girl presented with the physical and endocrinological stigmata of Cushing's disease. An adrenocorticotropic hormone (ACTH)-producing pituitary microadenoma was excised. Three weeks after trans-sphenoidal adenomectomy, the patient developed benign intracranial hypertension. Although ACTH levels had decreased to normal, the serum cortisol had fallen to subnormal levels. The child responded to exogenous steroid therapy, which was gradually tapered and discontinued after 5 months. Normal pituitary and adrenal functions persist 2 years later.
Atypical and Polymorphic Angioblastic Tumors of the Central Nervous System
Authors: Fabiani Armando , Torta Riccardo , Favero Maria , Brignolio Francesco , Benech Franco , Mostert Michael
Published: May 2010

Five central nervous system (CNS) polymorphic angioblastic tumors have been studied. Four were located in the posterior fossa and one involved the temporal lobe. In reviewing the literature, the authors point out the rarity of the supratentorial locations and of malignant hemangioblastomas. The clinical and anatomopathological peculiarities are discussed, as is the uncertain classification of two cases. The discrepancy between histology and outcome is focused upon in the other three cases. Finally, the diagnostic, prognostic, and nosographic difficulties posed by CNS angioblastic neoplasms are discussed.
Isodense Colloid Cysts of the Third Ventricle: A Diagnostic and Therapeutic Problem Resolved by Ventriculoscopy
Authors: Powell Michael P. , Torrens Michael J. , Thomson Gordon J. L. , Horgan Gerard J.
Published: May 2010

Eighteen patients with a colloid cyst of the 3rd ventricle presented to the Frenchay Hospital Neurosurgery Unit. The investigations included computed tomography (CT). Of these patients, 9 had radiographically isodense cysts that caused considerable diagnostic difficulties, being described only as an anterior 3rd ventricular space-occupying lesion and lateral ventricular dilatation in all but 2 cases. The clinical findings are described and the CT appearance is discussed. The new use of ventriculoscopy may resolve the problem rapidly; ventriculoscopy made the diagnosis in 5 cases and confirmed a CT diagnosis in 3 others. (It has also confirmed the diagnosis in 2 cases of hyperdense cysts.) Lately, it has been possible to aspirate the cyst contents endoscopically or, if the colloid is too viscous, to remove it with endoscopic rongeurs. After either of these procedures, the cyst wall can be coagulated with diathermy endoscopically. The method is described, and the advantages over other investigations and treatment are discussed.