bluuebunny/crossref_metadata_2025 huggingface dataset:
A neurosurgical nurse practitioner training program
Authors: Moody Robert A.
Published: May 2009

✓ A training program for neurosurgical nurse practitioners is described. The goals and alternative methods of training are described. The curriculum selected is explained in detail and the results are briefly considered, along with some remaining problems.
Paraplegia due to posttraumatic pelvic arteriovenous fistula treated by surgery and embolization
Authors: Weingrad Daniel N. , Doppman John L. , Chretien Paul B. , Di Chiro Giovanni
Published: May 2009

✓ A case is presented in which a posttraumatic pelvic arteriovenous fistula caused progressive paraplegia because of voluminous shunting into the epidural venous system. Surgical ligation and transcatheter embolization of major and minor arterial feeders decreased shunt flow sufficiently to permit direct embolization of the fistula by an injectable plastic. This combined approach may allow obliteration of unresectable acquired or congenital arteriovenous malformations.
Localized primary intracranial Ewing's sarcoma of the orbital roof
Authors: Alvarez-Berdecia Antonio , Schut Luis , Bruce Derek A.
Published: May 2009

✓ A rare case of a primary Ewing's sarcoma arising from the intracranial portion of the right orbital roof is presented. Clinical presentation was that of a rapidly growing tender exostosis, associated with headaches. History indicated that the tumor may have been present for more than 1 year. Skull x-rays showed marked diastasis of the coronal suture and a “mottled” appearance on the right frontal bone suggestive of a sarcoma. Bone scan further confirmed the presence of a malignant bone tumor. Computerized tomography scan showed the intracranial extension of the tumor and a follow-up scan allowed us to see the response of the tumor to therapy. Only two other cases with details as to intracranial localization were found in the literature.
Neurosarcoidosis with computerized tomographic visualization and transsphenoidal excision of a supra- and intrasellar granuloma
Authors: Decker Robert E. , Mardayat Maulana , Marc Joseph , Rasool Ayaz
Published: May 2009

✓ Neurological involvement in sarcoidosis frequently causes dysfunction of the optic nerves and neurohypophysis. Sarcoid granulomas in the suprasellar region have been previously diagnosed by pneumoencephalograms. A case is reported of visualization of a sarcoid granuloma by computerized tomography, followed by transsphenoidal excision. Resection of a localized granuloma should be entertained in very selective cases.
Glomus jugulare tumor presenting with increased intracranial pressure
Authors: Beck David W. , Kassell Neal F. , Drake Charles G.
Published: May 2009

✓ The authors report a case of glomus jugulare tumor presenting with papilledema and visual loss. The tumor was extremely vascular with significant shunting of arterial blood into venous sinuses. There was no intracranial extension of tumor, and papilledema resolved after removal of the lesion.
Familial intradural arachnoid cysts
Authors: Aarabi Bizhan , Pasternak Gavril , Hurko Orest , Long Donlin M.
Published: May 2009

✓ Two cases of intradural arachnoid cysts are reported in one family. The propositus was a 27-year-old woman with right inframammillary radicular pain and subjective weakness of the lower extremities. Her 57-year-old father was admitted with a progressive, painless paraparesis of 6 years' duration. Intradural arachnoid cysts, at T8–9 and T5–6, respectively, were found in both patients at the time of exploration.
Primary intracranial epidermoid carcinoma
Authors: Nosaka Yoshiki , Nagao Seigo , Tabuchi Kazuo , Nishimoto Akira
Published: May 2009

✓ A case is presented of primary intracranial epidermoid carcinoma in the right cerebellopontine angle which was visualized as a homogeneously enhanced mass on computerized tomography. At autopsy the malignant tissue was found to have invaded the brain stem.
Repair of cerebrospinal fluid fistula following transoral transclival approach to a basilar aneurysm
Authors: Yamaura Akira , Making Hiroyasu , Isobe Katsumi , Takashima Tsuneo , Nakamura Takao , Takemiya Sanzo
Published: May 2009

✓ A technique for closure of a cerebrospinal fluid fistula following a transoral transclival approach to a basilar aneurysm is described. Transposition of a rotation flap of the mucosa of the septum and the floor of the posterior nasal cavity in the choana resulted in complete closure of the thin and fragile nasopharynx without tension at the suture site.
Surgical treatment of giant intracranial aneurysms
Authors: Onuma Takehide , Suzuki Jiro
Published: May 2009

✓ The authors report the cases of 32 patients with aneurysms measuring 2.5 cm or greater in diameter found among 1080 patients with saccular cerebral aneurysms. Of the 32 patients, 24 patients were treated by direct operation, four by common carotid ligation, and the other four by conservative therapy. The appropriateness of surgery and surgical method are discussed.
The two-stage excision of huge acoustic neurinomas
Authors: Sheptak Peter E. , Jannetta Peter J.
Published: May 2009

✓ Total removal of huge acoustic neurinomas was carried out in 23 patients by means of a two-stage suboccipital transmeatal approach with microsurgical technique. There was no operative mortality. Good results were obtained in 18 (78%) of the patients who have returned to normal activities or full-time employment. Five patients (22%) have residual preoperative neurological deficits causing a reduced level of activity. All of these, except one, are able to care for themselves. None of the patients has had any further significant neurological deficit caused by the operative procedures. Anatomical integrity of the facial nerve was maintained in 17 patients (74%). Surgical technique, operative morbidity, and results are thoroughly discussed. The potential advantages of this technique are stressed.
The specificity of serum prolactin as a diagnostic indicator of pituitary adenoma
Authors: Balagura Saul , Frantz Andrew G. , Housepian Edgar M. , Carmel Peter W.
Published: May 2009

✓ Serum prolactin levels were determined in 205 patients with a variety of intracranial diseases, including 70 cases with pituitary tumors. It is concluded that although the absence of elevated prolactin levels does not help to rule out pituitary pathology, the presence of hyperprolactinemia is highly specific for diseases of the pituitary and hypothalamus, and prolactin determination should be part of the regular work-up of pituitary tumor suspects. Excluding known causes of hyperprolactinemia, such as tranquilizing drug ingestion, the presence of neurological disease outside the hypothalamic-pituitary area was not associated with increased serum prolactin concentrations.
Cytotoxic antibody responses in astrocytoma patients
Authors: Kornblith Paul L. , Pollock Linda A. , Coakham Hugh B. , Quindlen Eugene A. , Wood William C.
Published: May 2009

✓ Early diagnosis of brain tumors may be facilitated by a microcytotoxicity assay which the authors have used to detect a humoral immune response against an allogeneic glioblastoma cell line. Sixty-seven of 82 serum samples (82%) from astrocytoma patients elicited significant cytotoxicity, while only six of 65 samples (9%) from normal blood-bank donors demonstrated a similar response. Positive results were more frequently obtained in lower-grade astrocytomas. Meningiomas, acoustic schwannomas, pituitary adenomas, and metastatic tumors were positive in variable numbers of cases. A small series of serum samples were platelet-absorbed to insure that cytotoxicity was not merely due to histocompatibility antigens, and seven of eight samples, when retested on the target cell line, remained significantly positive. The assays were performed under strictly monitored conditions that afforded optimum reliability and minimal experimental variability. As the specificity of this test increases, it may lead to early detection of astrocytomas.
Composition of isolated edema fluid in cold-induced brain edema
Authors: Gazendam Jurjen , Go K. Gwan , van Zanten Annie K.
Published: May 2009

✓ Edema fluid isolated from cats with cold-induced brain edema was subjected to analysis of electrolyte content, enzyme activities, colloid osmotic pressure and the radioactivity of intravenously injected 99mTc-labeled albumin. The findings corroborate the essential features of vasogenic edema, such as its origin from the blood plasma, its rapid propagation into the white matter of the brain as contrasted with the delayed spread into gray matter, and its contribution to composition of cerebrospinal fluid. Moreover, the elevated activities of cellular enzymes and K+ content of edema fluid point to the admixture with cellular contents due to the freezing damage.
Recurrent subarachnoid hemorrhage associated with aminocaproic acid therapy and acute renal artery thrombosis
Authors: Tubbs Raymond R. , Benjamin Sanford P. , Dohn Donald E.
Published: May 2009

✓ Epsilon aminocaproic acid (EACA) has been used to prevent rebleeding in patients with subarachnoid hemorrhage (SAH). Although this agent does decrease the frequency of rebleeding, several reports have described thrombotic complications of EACA therapy. These complications have included clinical deterioration and intracranial vascular thrombosis in patients with SAH, arteriolar and capillary fibrin thrombi in patients with fibrinolytic syndromes treated with EACA, or other thromboembolic phenomena. Since intravascular fibrin thrombi are often observed in patients with fibrinolytic disorders, EACA should not be implicated in the pathogenesis of fibrin thrombi in patients with disseminated intravascular coagulation or other “consumption coagulopathies.”

This report describes subtotal infarction of the kidney due to thrombosis of a normal renal artery. This occlusion occurred after EACA therapy in a patient with SAH and histopathological documentation of recurrent SAH. The corresponding clinical event was characterized by marked hypertension and abrupt neurological deterioration.
Direct surgical treatment of bilateral intracavernous internal carotid artery aneurysms
Authors: Johnston Ian
Published: May 2009

✓ Bilateral intracavernous internal carotid artery aneurysms are described in a 3-year-old child. The etiology was uncertain, although the aneurysms may have been mycotic. As there was clinical and radiological evidence of progressive enlargement of both aneurysms, the more conventional forms of treatment were not applicable. A direct surgical approach was made to both aneurysms with exploration of the intracavernous portion of the internal carotid artery under deep hypothermia and cardiac arrest.
Cerebellar infarction resulting from traumatic occlusion of a vertebral artery
Authors: Heros Roberto C.
Published: May 2009

✓ A case is reported of a patient who suffered a gunshot wound of the neck which resulted in occlusion of a vertebral artery. Within a few hours he deteriorated neurologically to a comatose state with a gaze paresis and a facial paresis ipsilateral to the occluded vertebral artery. The diagnosis of cerebellar infarction with brain-stem compression was made clinically, and a posterior fossa decompression was carried out promptly. The patient has made an excellent recovery. Cerebellar infarction, like cerebellar hemorrhage, may act as a posterior fossa mass requiring neurosurgical decompression. This report emphasizes that such a pathological process may occur after certain injuries that are likely to result in occlusion of a vertebral artery.
Management of extracranial carotid stenosis and intracranial aneurysms
Authors: Stern Jack , Whelan Margaret , Brisman Ronald , Correll James W.
Published: May 2009

✓ Twenty patients with extracranial carotid stenosis and intracranial aneurysms are reviewed. Fifteen of these patients had transient ischemic attacks (TIA's) and incidental aneurysms. The other five presented with symptoms referrable to an aneurysm, and angiography revealed significant carotid stenosis. None of the patients who presented with TIA's and underwent endarterectomy suffered subarachnoid hemorrhage. However, those patients who presented with symptoms referrable to an aneurysm and underwent endarterectomy seem to be at greater risk for subarachnoid hemorrhage.
In vitro assay of contractile activities of spastic canine basilar artery and its surrounding blood clot
Authors: Tani Eiichi , Yamagata Shogo
Published: May 2009

✓ A prolonged vasospasm was produced in the canine basilar artery by injection of fresh autogenous arterial blood into the chiasmatic cistern. Homogenates of lyophilized normal and spastic canine basilar arteries, as well as of lyophilized blood clot around the spastic artery, were made, and their contractile activities were studied in vitro. The homogenates of the lyophilized spastic arteries usually induced a dose-dependent sustained contraction, whereas those of the lyophilized normal arteries often produced a dose-dependent transient contraction, and those of the lyophilized blood clot induced a dose-dependent transient or sustained contraction. The initial maximum contractions produced by the homogenates of the lyophilized normal and spastic arteries were significantly different in their values, suggesting the presence of a vasoactive agent in the spastic artery itself. Preliminary pharmacological analysis of the vasoactive agent was attempted using methysergide and phentolamine.
Percussive injury to peripheral nerve in rats
Authors: Richardson Peter M. , Thomas Peter K.
Published: May 2009

✓ Weights were dropped on rat sciatic nerves. Teased fibers and light and electron micrographs of nerves removed between 10 minutes and 2 weeks later were examined. Axonal alterations were seen 10 minutes after injury, and subsequently interruption of axonal continuity with preservation of the basal lamina was apparent. Dissolution of myelin began within 30 minutes and progressed. At 4 days, a segment of some large fibers was devoid of myelin and, by 2 weeks, remyelination had commenced. Demyelination of a significant number of fibers was always accompanied by Wallerian degeneration of other fibers of the same nerve. Percussive injury of nerves caused a mixed lesion in which the early and late pathological features were clearly distinguishable from those following crush or compression by a cuff. Any explanation of the transient interruption of function that has been described following such an injury is at present speculative.
Cavernous hemangioma of the orbit
Authors: Harris Gerald J. , Jakobiec Frederick A.
Published: May 2009

✓ The clinical and pathological data of 66 patients with orbital cavernous hemangioma are presented. This tumor occurs in females more frequently than in males, and has its peak incidence in early middle age. Visual disability results from a high degree of relative hyperopia or from optic-nerve compression. Postural or temporal variation in proptosis is not characteristic. Multiple cavernous hemangiomas are rare, but may occur simultaneously or separated by long intervals. In this series, incompletely excised lesions did not cause recurrent proptosis. Relative hyperopia may persist, in spite of complete removal of the tumor. Improved preoperative localization with modern techniques appears to be reducing the morbidity associated with surgical excision of the lesion. A local hemodynamic disturbance may initiate proliferation of vascular channels that undergo progressive ectasia. Growth of the lesion may occur intrinsically by the budding-off of capillary channels from cavernous spaces into the interstitium. Clinical and pathological findings fail to demonstrate any relationship between this lesion and capillary hemangioma of childhood.
Familial lumbar spinal stenosis with acute disc herniations
Authors: Varughese George , Quartey Gilbert R. C.
Published: May 2009

✓ The case histories are reported of four brothers with lumbosciatic syndrome due to acute disc herniations, and associated spinal stenosis. Hereditary factors, although not hitherto reported, may be implicated for these spinal lesions, as the parents had also undergone spinal operations previously.
Occlusion of cerebral artery due to metastasis of chorioepithelioma
Authors: Nakagawa Yoku , Tashiro Kunio , Isu Toyohiko , Tsuru Mitsuo
Published: May 2009

✓ A case of cerebral metastasis of chorioepithelioma with an occlusion of the angular artery is presented. The occlusion was verified angiographically, surgically, and microscopically.
Spinal subarachnoid metastatic spread from non-neuraxial primary neoplasms
Authors: West Charles G. H.
Published: May 2009

✓ A rare case of metastasis to the spinal subarachnoid space from a non-neuraxial primary tumor is presented. Dissemination was shown by computerized tomography to be via the cerebrospinal fluid from secondary deposits in the central nervous system and meninges. This route would seem to be the most common mode of spread to the spinal subarachnoid space.
Acute spontaneous otorrhagia resulting from a ruptured petrous carotid aneurysm
Authors: Holtzman Robert N. N. , Parisier Simon C.
Published: May 2009

✓ A 35-year-old man experienced sudden spontaneous arterial bleeding from his left ear. Arteriography demonstrated a left petrous carotid aneurysm. The bleeding was initially controlled with packing and ultimately by left common carotid ligation and transection.
Clinical endocrinological approach to hypothalamic-pituitary disease
Authors: Abboud Charles F. , Laws Edward R.
Published: May 2009

✓ The authors review the present knowledge of the hypothalamic-pituitary endocrine axis. The physiology and pathophysiology are discussed along with outlines of standard approaches to diagnosis of disorders. An appendix of useful provocative tests is included.
Dexamethasone and severe head injury
Authors: Cooper Paul R. , Moody Sarah , Clark W. Kemp , Kirkpatrick Joel , Maravilla Kenneth , Gould A. Lawrence , Drane Wanzer
Published: May 2009

✓ A prospective double-blind study of the effects of dexamethasone administration on the outcome of patients with severe head injuries was performed. Patients were stratified for severity of neurological injury and were treated with placebo, low-dose dexamethasone (16 mg/day), or high-dose dexamethasone (96 mg/day) for a period of 6 days. Outcome was evaluated at 6 months following injury. Of the 76 patients available for analysis, a good outcome was achieved in 37% of placebo-treated patients, 44% of low-dose-treated patients, and 29% of high-dose-treated patients. These differences are not statistically significant. Similarly dexamethasone administration had no statistically significant effect on intracranial pressure patterns or serial neurological examinations during hospitalization. Gastrointestinal bleeding occurred in only one patient. Good outcome was associated with age under 10 years, lighter depth of coma on admission, and the preservation of brain-stem reflexes upon admission. A recalculation of data in previous clinical series purporting to show an improvement in outcome as a result of corticosteroid therapy shows no significant difference in outcome when steroid- and placebo-treated patients are compared. In our series, 90% of all deaths were caused by recurrent intracranial hematomas, medical complications, or diffuse brain injuries with parenchymal hemorrhage and tissue disruption — causes of death which cannot be affected by corticosteroid therapy. The study suggests that dexamethasone in either high or low dosages has no significant effect on morbidity and mortality following severe head injury.
Experimental interfascicular nerve grafting
Authors: Bratton Bert R. , Kline David G. , Coleman William , Hudson Alan R.
Published: May 2009

✓ Twenty-nine adult rhesus monkeys underwent complete laceration of both tibial nerves at mid-thigh level and repair by different methods to study the relative efficacy of autogenous interfascicular nerve grafts. Sixteen animals in Group I had an interfascicular graft repair using short sural nerve autografts on one limb and fascicular repair without grafts on the other limb. Thirteen animals in Group II, after having a 1-cm segment of tibial nerve resected, had an interfascicular graft repair without tension in one limb and an epineurial repair under moderate tension in the other limb. Evoked nerve and muscle action potentials and muscle strength in response to repetitive and tetanic stimulation were recorded as baseline values prelaceration and then on re-exploration at 4, 6, 9, or 12 months. All nerves were examined by light and electron microscopy.

Electrophysiological data, particularly muscle strength response, showed non-graft repairs to be superior at 4 and 6 months of regeneration. However, by 9 and 12 months the graft repairs had caught up and were equal to the non-graft repairs. Histologically, it was observed that many axons missed the graft segments and were present in extrafascicular connective tissues. Nonetheless, enough axons regenerated to the distal nerve to explain the success of these relatively short grafts. From the results of these experiments, it is concluded that use of autogenous interfascicular grafts offers no advantage over end-to-end non-graft repair. When an end-to-end repair cannot be achieved, use of short interfascicular nerve grafts is feasible and will work.
Histological studies of experimental interfascicular graft repairs
Authors: Hudson Alan R. , Hunter Daniel , Kline David G. , Bratton Bert R.
Published: May 2009

✓ Biopsies of sutured and grafted primate peripheral nerves were examined by light and electron microscopy after the final set of electrical measurements had been recorded. Inspection of all proximal stumps showed the expected regenerative activity which was not affected by the nature of the nerve repair. Transverse sections through the epineurial, interfascicular, and graft suture lines showed a similar pattern in all animals and at this site nerves sutured by epineurial technique could only be distinguished from those sutured by fascicular technique by loci of the non-absorbable suture. Fascicular repairs, whether done fascicle-to-fascicle or with interposition of grafts, had a more lengthy neuroma than did the epineurial repairs. Maintenance of fascicular architecture through the course of the grafts was variable. Fascicular structure was frequently absent in the central graft segments and in segments close to the second suture site. The method of repair used more proximally could not be distinguished by evaluation of distal stump segments. Measurements of myelinated fiber size made of distal stump axons revealed no statistical difference between the methods of repair.
Ventricular dilatation and communicating hydrocephalus following spontaneous subarachnoid hemorrhage
Authors: Vassilouthis John , Richardson Alan E.
Published: May 2009

✓ Ventricular dilatation following spontaneous subarachnoid hemorrhage (SAH) is a well recognized phenomenon. Its clinical significance, however, remains controversial. Two phases are distinguished, the acute or early, occurring soon after the ictus, and the chronic or late, developing after the second week. The authors studied the ventricular size in 210 patients with spontaneous SAH through the course of their illness and convalescence by means of serial computerized tomography (CT) scans. Their findings suggest that ventricular dilatation soon after SAH is not always clinically significant and does not necessarily require shunting before definitive surgery. Delayed symptomatic ventricular enlargement (communicating hydrocephalus) occurs in 7% of the patients and can be safely diagnosed on the basis of the clinical picture and CT scan appearances. Treatment with a ventricular shunting system is almost invariably rewarding.
New data on diastematomyelia
Authors: Kennedy Philip R.
Published: May 2009

✓ Five cases of diastematomyelia are described and illustrated. These and a further 60 cases from the literature are analyzed. The data corroborate the opinion that early diagnosis and treatment result in a better prognosis.
Alphafetoprotein and human chorionic gonadotropin determination in cerebrospinal fluid
Authors: Allen Jeffrey C. , Nisselbaum Jerome , Epstein Fred , Rosen Gerald , Schwartz Morton K.
Published: May 2009

✓ The cerebrospinal fluid (CSF) and serum of six patients with histologically verified intracranial germ-cell tumors were assayed serially for the presence of alphafetoprotein (AFP) and the beta subunit of human chorionic gonadotropin (HCG). Two patients had embryonal carcinomas, two had choriocarcinomas, and two had dysgerminomas. The marker profile for a given tumor in either CSF or serum correlated with the histological diagnosis; that is, embryonal carcinoma produced AFP and HCG, choriocarcinoma produced HCG, and dysgerminoma produced no markers. The marker levels in serum and CSF declined with therapy and rose usually prior to the development of overt clinical symptoms if the patient's tumor recurred. A CSF-to-serum gradient of the marker levels was present in three of four patients, and the serum levels were often normal when the CSF values were elevated. Ventricular marker levels were lower than the lumbar levels in two of two patients. The assay of these biological markers is a sensitive indicator of the success of therapy, and the presence of a CSF-to-serum gradient suggests that the major portion of the neoplasm rests within the central nervous system. A histological diagnosis can be inferred without the necessity of surgery in appropriate clinical contexts.
Traumatic asphyxia: an unusual cause of traumatic coma and paraplegia
Authors: Ectors Paul , Bosschaert Thierry , Vincent Gisele , Franken Lucien
Published: May 2009

✓ An unusual case of traumatic asphyxia with cerebral and spinal cord symptoms is presented. A survey of the literature indicates that a primary cord lesion is very rare as a consequence of such a trauma. The possible pathogenetic mechanisms of these neurological manifestations are discussed.
Extraspinal ependymomas
Authors: Morantz Robert A. , Kepes John J. , Batnitzky Solomon , Masterson Byron J.
Published: May 2009

✓ Spinal ependymomas may rarely arise from heterotopic ependymal cell clusters and thus occur in an extraspinal location. Presentation of three cases and a review of the literature reveal that these tumors have characteristic radiographic and clinical features. They occur mainly in patients in the third decade of life, and present either in the soft tissue posterior to the sacrum or in the pelvis. In the case of posterior tumors, the patient exhibits a mass which is usually mistaken for a pilonidal cyst. Patients whose tumor is pelvic in location present with sphincter disturbances or dysfunction of the sacral nerve roots. Conventional and computerized tomographic studies will reveal erosion of the sacrum. Myelography will demonstrate an extradural mass indenting the thecal sac from below. The protein in the cerebrospinal fluid will be normal. A combined posterior and anterior approach with the goal of complete tumor removal is the procedure of choice. If this is not feasible, then radiation therapy should be employed. Because of the increased incidence of systemic metastases, the average postoperative survival is approximately 10 years.
Sphenoethmoidal meningoencephalocele associated with agenesis of corpus callosum and median cleft lip and palate
Authors: Sakoda Katsuaki , Ishikawa Susumu , Uozumi Tohru , Hirakawa Katsuhiro , Okazaki Hideo , Harada Yasuo
Published: May 2009

✓ A case of sphenoethmoidal meningoencephalocele associated with agenesis of the corpus callosum and median cleft lip and palate in a baby boy is reported. Two other cases have been reported previously presenting exactly the same findings. It is possible that these malformations constitute a distinct type of congenital anomaly.
Sphenoidal pneumosinus dilatans with bilateral optic nerve meningiomas
Authors: Hirst Lawrence W. , Miller Neil R. , Allen George S.
Published: May 2009

✓ The authors report a case of bilateral progressive visual loss in a patient with a radiological diagnosis of sphenoidal pneumosinus dilatans. At craniotomy, bilaterally symmetrical meningiomas of the optic nerve sheaths were found at the intracranial optic foramina. Reported cases of sphenoidal pneumosinus dilatans as well as bilateral meningiomas of the optic nerve sheaths are reviewed. The possible mechanisms of visual loss in pneumosinus dilatans and the management of nerve sheath and planum sphenoidale meningiomas are discussed.
Primary cerebellar nocardiosis
Authors: Tyson George W. , Welsh Joseph E. , Butler Albert B. , Jane John A. , Winn H. Richard
Published: May 2009

✓ The authors describe two cases of primary cerebellar nocardiosis. Confinement of Nocardia abscesses to a localized, accessible portion of the central nervous system should favor surgical cure of this aggressive and often fatal disease. In our two cases multilocularity, tenuous encapsulation, and proximity to the brain stem prevented complete primary excision. Nevertheless, the infections were effectively treated by intensive postoperative antibiotic therapy and, in one case, a second operation to excise the residual abscess. The need for the latter was suggested by the results of sequential computerized tomographic brain scans that were used to monitor the response to antibiotic therapy.

In the absence of any apparent extracranial focus of infection and any overt condition that might impair immunological competence, nocardiosis is likely to be omitted from the preoperative differential diagnosis of a posterior fossa space-occupying lesion.
Microsurgical treatment of intracranial vascular malformations
Authors: Wilson Charles B. , U Hoi Sang , Domingue James
Published: May 2009

✓ In the period 1968 to 1978, 83 vascular malformations (AVM's) were treated by operation: 65 were excised and 18 were managed by interruption of afferent arteries. Three cryptic AVM's (two in the thalamus and one in the caudate nucleus) were discovered during exploration of hematomas in normotensive young women. All three of these small malformations were detected on computerized tomographic scans; none was apparent on preoperative angiograms. Two of the four deaths in this series occurred after excision of large, high-flow fistulas; the proposed cause was restoration of normal perfusion pressure in a chronically ischemic hemisphere rendered incapable of autoregulation. The addition of operative adjuncts, in particular, bipolar coagulation and operative microscopy, has extended traditional indications for operation to include favorably situated AVM's that have not bled and certain AVM's situated in critical regions of the brain.
Superficial temporal-middle cerebral artery bypass
Authors: Latchaw Richard E. , Ausman James I. , Lee Myoung C.
Published: May 2009

✓ Pre- and postoperative angiograms on 40 patients undergoing superficial temporal-middle cerebral artery (STA-MCA) bypass surgery have been examined in detail. Multiple postoperative angiograms have been obtained to evaluate the change in both the bypass circuit and the intracranial circulation over time. A reproducible system for evaluating the degree of intracranial vascular filling via the bypass is introduced.

The study shows that the STA and its anastomotic branch increase in size over time, measured in months, in the majority of patients. This is paralleled by a progressive increase in the degree of intracranial vascular filling. These changes are proportional to the severity of the vascular disease before surgery. The pattern of preoperative collateral circulation may change over time following the addition of the bypass circuit. The progressive change over time suggests that a static analysis at one time may belie the true effect of the surgery. The change of collateral circulation, with augmentation of blood supply to areas of the brain other than those affected by the recent ischemic event, means that a total cerebral evaluation including neuropsychological testing may be necessary for adequate evaluation of the effect of the bypass surgery.
Vasospasm assessed by angiography and computerized tomography
Authors: Saito Isamu , Shigeno Taku , Aritake Koichi , Tanishima Takeo , Sano Keiji
Published: May 2009

✓ In 44 consecutive cases of ruptured cerebral aneurysm, vasospasm was demonstrated pre- or postoperatively. These cases were examined by bilateral carotid angiography and computerized tomography (CT), and the relationship between the angiographically visualized distribution of vasospasm, the neurological symptoms, and infarction seen on CT was evaluated. Vasospasm occurred in only some intracranial portions of the cerebral arteries that were immersed in blood-stained cerebrospinal fluid. Angiographically, diffuse vasospasm extensively involving bilateral carotid systems indicated the gravest prognosis for patients. Vasospasm affecting one carotid system and the anterior cerebral arteries on the opposite side often produced permanent neurological deficits. On the contrary, when vasospasm was restricted to one carotid system or to bilateral anterior cerebral arteries, it was usually associated with temporary neurological symptoms; however, it always produced residual neurological symptoms if it extended to the ascending branches (M3) of the middle cerebral arteries. Computerized tomography definitely demonstrated a low-density area or infarction in the territory of the spastic arteries in 25 (71%) of 35 cases with vasospasm. A low-density area was always detected when vasospasm occurred in M3 segments.
Prophylactic phenytoin in severe head injuries
Authors: Wohns Richard N. W. , Wyler Allen R.
Published: May 2009

✓ We are reporting a retrospective study of 62 patients whose head injury was sufficiently severe to cause a high probability of posttraumatic epilepsy. Of 50 patients treated with phenytoin, 10% developed epilepsy of late onset. Twelve patients not treated with phenytoin but who had head injuries of equal magnitude had a 50% incidence of epilepsy. These data from a highly selected group of patients with severe head injuries confirm the bias that treatment with phenytoin decreases the incidence of posttraumatic epilepsy.
Cerebrospinal fluid conductance and compliance of the craniospinal space in normal-pressure hydrocephalus
Authors: Børgesen Svend Erik , Gjerris Flemming , Sørensen Søren Claus
Published: May 2009

✓ Conductance to outflow of cerebrospinal fluid (CSF) has been measured by both a lumboventricular perfusion and a bolus injection method in 24 patients with normal-pressure hydrocephalus. One purpose was to investigate whether the less time-consuming technique of bolus, injection gave results comparable to the results obtained by the lumboventricular perfusion technique. There was a poor correlation between the results obtained by the two measurements of conductance to outflow of CSF. It is concluded that the bolus-injection technique cannot substitute for the lumboventricular perfusion test. Compliance of the CSF space was measured by the bolus injection. The presence of B-waves, recorded from long-term intraventricular pressure monitoring, could be correlated to the sum of conductance to outflow and compliance. The correlation offers a possible explanation of the nature of B-waves.
A Phase III comparison of BCNU, hydroxyurea, and radiation therapy to BCNU and radiation therapy for treatment of primary malignant gliomas
Authors: Levin Victor A. , Wilson Charles B. , Davis Richard , Wara William M. , Pischer Tana L. , Irwin Lowell
Published: May 2009

✓ This Phase III clinical trial compared the effectiveness of the combination of 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU), radiation therapy, and hydroxyurea (BHR group) to the combination of BCNU and radiation therapy (BR group) for the treatment of malignant gliomas. In both arms of the study, BCNU was administered intravenously for 3 consecutive days before the initiation of radiation therapy, and at 8-week intervals thereafter until unequivocal tumor progression. In the BHR arm of the study, hydroxyurea was administered orally on alternate days during radiation therapy. Patients in each arm were stratified almost equally by tumor type (glioblastoma multiforme (GM) or other nonglioblastoma multiforme malignant gliomas (NGM)) and extent of surgical resection of tumor. Patients were also evaluated with the Karnofsky Performance Status (KPS) scale. Time to progression was determined by comparing the results of sequential neurological examinations and radionuclide and computerized tomographic scans.

Of the 130 patients entered into the study, 99 constitute the valid study group. Data were analyzed with Kaplan-Meier representations and the statistical methods of Gehan and Cox. The NGM patients with KPS ratings of ≥60 did better on both arms of the study, with median times to tumor progression (MTP's) of 50 and 72 weeks for BHR and BR, respectively. However, GM patients showed statistically significant differences (p = 0.03) between the two arms of the study, with MTP's of 41 and 31 weeks for BHR and BR, respectively. The GM patients with subtotal tumor resection did slightly better on BHR than on BR, with MTP's of 49 weeks (p = 0.03) and 31 weeks for the respective groups.
Internuclear ophthalmoplegia following head injury
Authors: Baker Robert S.
Published: May 2009

✓ The most common causes of internuclear ophthalmoplegia (INO) are multiple sclerosis and vascular disease of the brain stem. Rarer causes are tumor, Arnold-Chiari malformation, and syphilis. Myasthenia gravis has, on occasion, presented with ocular abnormalities indistinguishable from INO. A case is described of bilateral INO of brief duration following head trauma. There were no other brain-stem abnormalities. This brings to 11 the number of reported patients in whom head trauma precipitated this abnormality.
Microneurosurgery for aneurysms of the basilar artery
Authors: Sugita Kenichiro , Kobayashi Shigeaki , Shintani Akira , Mutsuga Naomi
Published: May 2009

✓ The authors report microsurgical treatment in 32 cases of basilar artery aneurysms, operated on with good results in 28 cases, fair results in one, and poor results in one; there were two deaths. Twenty-nine patients (91%) were able to return to social activities. Characteristics of the surgical techniques include 1) taking a transsylvian route; 2) retracting the M1 portion of the middle cerebral artery (occasionally the C1 portion of the internal carotid) medially with tapered brain retractors; and 3) approaching the aneurysm through and between perforators arising from the posterior cerebral artery in cases of high-placed basilar bifurcation. With regard to instrument improvements, tapered brain retractors, a multipurpose head frame, and bayonet clips (Sugita design) proved very helpful.
Subclavian steal syndrome
Authors: Bohmfalk George L. , Story Jim L. , Brown Willis E. , Marlin Arthur E.
Published: May 2009

✓ Three patients with central nervous system symptoms due to subclavian steal syndrome were treated with proximal vertebral to common carotid artery transposition. Neurological symptoms were relieved or improved in all three, with no decrease in blood pressure or pulse in the ipsilateral upper extremity. The colorful history of this syndrome is reviewed, and the various surgical approaches to its treatment are discussed. Although the literature suggests that the commonly used carotid to subclavian artery bypass graft and other similar extrathoracic procedures are generally safe and effective for relief of symptoms of the steal, there is also evidence that these bypasses may fail to restore antegrade flow in the vertebral artery, and, in fact, may steal from the carotid artery. Thus, the blood flow provided to the brain by these procedures may be hardly more than that provided by vertebral artery ligation, whereas the principal effect is to restore blood flow into the upper extremity. Vertebral artery ligation alone has been used in 20 patients, with neurological improvement in all cases and production of persistent intermittent brachial claudication in only one. These considerations and our patient experience suggest that a relatively simple operation, proximal vertebral to common carotid artery transposition, which emphasizes restoration of flow to the brain rather than to the upper extremity, may be preferable for most patients with neurological symptoms of subclavian steal syndrome.
Acute cerebral revascularization after regional cerebral ischemia in the dog
Authors: Diaz Fernando G. , Mastri Angeline R. , Ausman James I. , Chou Shelley N.
Published: May 2009

✓ The efficacy of cerebral revascularization by anastomosis of the superficial temporal artery (STA) to the middle cerebral artery (MCA), performed 4 and 24 hours after a regional MCA infarction had been produced by combined occlusion of the MCA and internal carotid artery, was tested in 12 dogs. To control possible intercurrent variables, seven other dogs remained untreated and five had a sham operation. Clinical and pathological changes were recorded and analyzed. An incidence of 85% infarction was obtained in the untreated control group. The severity of the clinical deficits and pathological changes for the anastomosed groups were greater than those seen in the untreated control group. The extent of the infarction was significantly greater (p < 0.05) in the anastomosed groups than in the sham-operated and control groups. Hemorrhagic infarcts occurred in most of the dogs in the anastomosed groups, but were not present in either control group (p < 0.05). Two dogs in the 4-hour and one in the 24-hour group improved more than any control dog, but the difference was not statistically significant (p > 0.05). In two dogs with occluded anastomosis the clinical deficits and the pathological changes were less than those seen in animals with patent anastomosis. The severity of the pathological and clinical changes correlated well with the re-establishment of flow in the MCA territory. It is proposed that cerebral revascularization at 4 and 24 hours following a regional MCA infarct in the dog is followed by an exacerbation of the microcirculatory obstruction, cerebral edema, and infarction. From improvement noted in three animals the authors suggest that under special conditions the revascularization could benefit some cases following acute cerebral infarction.
Anterior fibular strut graft in neoplastic disease of the cervical spine
Authors: Conley Frances K. , Britt Richard H. , Hanbery John W. , Silverberg Gerald D.
Published: May 2009

✓ An anterior operative procedure using a strut of fibular graft material was performed either alone or in combination with a posterior stabilization in five patients with cervical spine instability secondary to neoplastic disease. Osseous tumor was present in four of the five patients (osteoblastoma, metastatic adrenal carcinoma, metastatic renal cell carcinoma, multiple myeloma) and the fifth had spine instability as a result of a posterior decompression for cervical spinal cord glioma. The anterior approach using fibula to replace diseased vertebrae and provide axial support for the neck was a valuable therapeutic modality in this group of patients, all of whom had a limited life expectancy. Cervical spine stability obtained by operative intervention led to a reduction of neck pain and maintenance of ambulation until the neoplastic condition became terminal.
Production of experimental brain abscess in the rat
Authors: Winn H. Richard , Mendes Michael , Moore Paul , Wheeler Clarabelle , Rodeheaver George
Published: May 2009

✓ Experimental evaluation of brain abscess has been inhibited by the lack of a simple and reproducible model in small animals. A stereotaxic headholder and slow infusion of 1 µl of saline, containing a known number of bacteria, were used to produce brain abscess consistently in the rat. The natural history of the brain abscess produced by this technique closely simulated that found in the human clinical situation.
Subtotal neonatal calvariectomy
Authors: Mabbutt Laurence W. , Kokich Vincent G. , Moffett Benjamin C. , Loeser John D.
Published: May 2009

✓ A subtotal calvariectomy was performed on rabbits between 10 and 14 days of age. The animals were allowed to grow and were then sacrificed serially so that the sutural and skeletal redevelopment could be analyzed through a combination of gross, radiographic, and histological techniques. The results indicate that calvarial regeneration is a progressive process with a definite pattern and rate of development. During the regenerative process, bone was deposited both at the surgical margin and as islands within the surgical defect. The eventual approximation of these areas of ossification produced multiple fibrous articulations. The majority of these articulations were obliterated by bone union, except for the midsagittal, coronal, and metopic sutures, which were re-established in their appropriate anatomical positions. The maintenance of dural integrity during the surgical phase and the regeneration and establishment of pericranial continuity during the postoperative period were believed to be important in the re-establishment of normal sutural and skeletal architecture.
Carotid-cavernous fistula following percutaneous retrogasserian procedures
Authors: Sekhar Laligam N. , Heros Roberto C. , Kerber Charles W.
Published: May 2009

✓ Carotid arterial puncture during percutaneous retrogasserian procedures is a common but usually harmless complication. Strokes, resulting presumably from carotid artery thrombosis, have been reported previously following percutaneous retrogasserian coagulation. The authors report two cases of carotid-cavernous fistula, one following percutaneous radiofrequency rhizotomy and the other after percutaneous retrogasserian block. The latter patient had an anomalous primitive foramen lacerum. Both fistulas were obliterated successfully by intracavernous injection of isobutyl-2 cyanoacrylate, using intra-arterial balloon flotation catheters. Carotid-cavernous fistula is a potentially serious complication of such procedures, and may be more common than realized since small fistulas may close spontaneously.
False aneurysm of the cavernous carotid artery and progressive external ophthalmoplegia after transsphenoidal hypophysectomy
Authors: Paullus Wayne S. , Norwood Christopher W. , Morgan Howard W.
Published: May 2009

✓ A case is reported in which a large false aneurysm and small associated fistula formed in the cavernous carotid artery as the result of laceration at the time of transsphenoidal surgery. The clinical syndrome associated with the enlarging mass and the surgical management of the lesion itself are described. The value of the midline approach to the sella is stressed, along with anatomical variants of the carotid artery.
Extradural hematoma in the neonate
Authors: Merry Glen S. , Stuart Gordon
Published: May 2009

✓ A neonate with an extradural hematoma unassociated with trauma or skull fracture is reported. Umbilical hemorrhage was also present.