bluuebunny/crossref_metadata_2025 huggingface dataset:
One-knot microvascular anastomosis
Authors: Iwasa Hideaki , Sato Fumiaki , Shimabukuro Hiroshi , Yamada Naoshi , Ikada Yoshito , Hyon S. H.
Published: May 2009

✓ Experimental microvascular anastomosis using a glutide copolymer (lactide:glycolide, 80:20) as an external splint was undertaken in 33 rats between the carotid artery and the jugular vein. Both vessels were dissected free over a 1-cm length and cut at the cranial end of the dissected part. The carotid artery was then introduced into a glutide pipe-splint. The arterial wall was turned 180° over the edge of the splint. This reflected artery wall and the glutide were covered by the freed-up jugular vein. One stitch was made around the vein, the artery, and the glutide in a manner similar to binding steel wire over a barrel. Thus, the “one-knot anastomosis” was completed.

The patency rate at the anastomosed site was 100%, confirmed by angiography in 30 rats and by direct surgery in three. The time required to produce the anastomosis was between 5 and 7 minutes. Light microscopic observation showed that there was no obstruction by thrombus formation at 1 and 5 weeks after the anastomotic surgery. This technique may be clinically applicable for extracranial-intracranial bypass surgery, reconstruction of venous sinuses, and other vascular procedures.
Traumatic arteriovenous fistula of the scalp
Authors: Badejo Leke , Rockwood Peter
Published: May 2009

✓ A case of an arteriovenous fistula resulting from an air-rifle pellet injury to the scalp is reported. Traumatic arteriovenous fistulas of the scalp are rare lesions. A suggested pathogenesis is a disruption of the arterial wall and its vasa vasorum with endothelial proliferation to adjacent veins. Classically, these fistulas are described as single channels, but more commonly they consist of multiple connections. Angiography is necessary to delineate the full extent of the lesions unless they are extremely small. Careful complete excision is the definitive management, as recurrences are common.
Subarachnoid hemorrhage following chymopapain chemonucleolysis
Authors: Cusick Joseph F. , Ho Khang-Cheng , Schamberg Jay F.
Published: May 2009

✓ Subarachnoid hemorrhage is a frequent finding in patients who have incurred neurological complications following chymopapain chemonucleolysis, but the basis for this occurrence remains controversial. The authors report the clinical and postmortem findings in a 42-year-old man who died 5 days after chemonucleolysis at the L4–5 and L5–S1 disc spaces. The predominant histological abnormality was a severe inflammatory arteritis of a medium-sized artery at the upper cervical level with disruption of the vessel wall. The potential causative role of chymopapain in this situation and the correlation of a vascular basis for many of the complications found after inadvertent intrathecal chymopapain injection are discussed.
Emergency carotid endarterectomy
Authors: Walters Bradford B. , Ojemann Robert G. , Heros Roberto C.
Published: May 2009

✓ A retrospective review of carotid endarterectomies performed by the Neurosurgical Service at Massachusetts General Hospital from July, 1976, through December, 1985, disclosed 64 procedures that were performed on an emergency basis. The patients included 40 men and 24 women, with a mean age of 64 years (range 32 to 87 years). Correlation of angiographic findings with outcome revealed that of the 27 patients with severe stenosis, usually with delay in blood flow, 25 (93%) were the same or improved postoperatively; of the 11 patients with stenosis and an intraluminal filling defect (six of whom had an intraluminal clot), eight (73%) were the same or improved after surgery; of the 16 patients with complete occlusion, 14 (88%) were the same or improved (backflow was established in all cases); and of the 10 patients with moderate to severe stenosis and/or severe ulceration (including three with transient ischemic attacks who were receiving heparin), eight (80%) were the same or improved.

Pre- and postoperative clinical status were graded into five categories: intact; mild deficit; moderate deficit (significant impairment but able to perform activities of daily living); severe deficit (requiring assistance for daily activities); and death. Of the 36 patients who preoperatively were intact or had mild deficits, 33 (92%) were the same or improved postoperatively, three were worse, and there were no deaths. Among 15 patients presenting with moderate deficits, 12 (80%) were the same or improved, two were worse, and one died. Of the 13 patients with severe deficits, 10 (77%) were the same or improved and three died. Two patients with sudden severe deficits associated with loss of contralateral bruit were operated on without angiography and were intact postoperatively. Of the four deaths in the total series, two were attributed to cardiac causes and two to unrelated disease processes. The indications for emergency carotid endarterectomy are discussed.
Tandem lumbar and cervical spinal stenosis
Authors: Dagi T. Forcht , Tarkington Mary Ann , Leech James J.
Published: May 2009

✓ Spondylotic degeneration can give rise to concurrent stenosis of the lumbar and cervical portions of the spinal canal in tandem. Symptomatic tandem spinal stenosis (TSS) is characterized by the triad of intermittent neurogenic claudication, progressive gait disturbance, and findings of mixed myelopathy and polyradiculopathy in both the upper and lower extremities. Nineteen patients with clinically symptomatic and myelographically proven disease were studied retrospectively. Surgical intervention was directed at decompression of the stenotic lesions in both the cervical and lumbar regions. The most symptomatic level was usually treated first. After a mean follow-up period of 22 months, an excellent outcome was obtained in five patients (26%), four improved (21%), five deteriorated despite initial improvement (26%), and one was unchanged. Three patients could not be traced for follow-up review, and there was one postoperative death. Postoperative improvement correlated inversely with symptom duration. Sphincter disturbance, radiculopathy, myelography, cerebrospinal fluid analysis, and electrophysiological data were not prognostically significant. The presentation of TSS mimics amyotrophic lateral sclerosis and other forms of motor-neuron disease. In contrast to these conditions, however, TSS is amenable to treatment. Operative sequence and technique could not be related to outcome. Functional recovery in TSS depends on early diagnosis and timely surgical intervention.
Quantitative estimation of hemorrhage in chronic subdural hematoma using the 51Cr erythrocyte labeling method
Authors: Ito Haruhide , Yamamoto Shinjiro , Saito Kenichi , Ikeda Kiyonobu , Hisada Kinichi
Published: May 2009

✓ Red cell survival studies using an infusion of chromium-51-labeled erythrocytes were performed to quantitatively estimate hemorrhage in the chronic subdural hematoma cavity of 50 patients. The amount of hemorrhage was determined during craniotomy. Between 6 and 24 hours after infusion of the labeled red cells, hemorrhage accounted for a mean of 6.7% of the hematoma content, indicating continuous or intermittent hemorrhage into the cavity. The clinical state of the patients and the density of the chronic subdural hematoma on computerized tomography scans were related to the amount of hemorrhage. Chronic subdural hematomas with a greater amount of hemorrhage frequently consisted of clots rather than fluid.
The predictive value of catecholamines in assessing outcome in traumatic brain injury
Authors: Woolf Paul D. , Hamill Robert W. , Lee Louyse A. , Cox Christopher , McDonald Joseph V.
Published: May 2009

✓ Because of the central role of the sympathetic nervous system in mediating the stress response, plasma norepinephrine (NE), epinephrine (E), and dopamine (DA) levels were measured in 61 traumatically brain-injured patients to determine whether catecholamine (CA) levels obtained within 48 hours after injury provide reliable prognostic markers of outcome. Patient outcome was determined at 1 week using the Glasgow Coma Scale (GCS) and at the time of discharge using the Glasgow Outcome Scale (GOS). Levels of NE, E, and DA correlated highly with the admission GCS score (NE: r = 0.58, p < 0.0001; E: r = 0.46, p < 0.0025; DA: r = 0.27, p < 0.04). Moreover, in the 21 patients with GCS scores of 3 or 4 on admission, NE levels predicted outcome at 1 week. All six patients with NE levels less than 900 pg/ml (normal level less than 447 pg/ml) improved to GCS scores of greater than 11, while 12 of 15 with NE values greater than 900 pg/ml remained with GCS scores of 3 to 6 or died. Levels of E and DA were not as useful. Catecholamine levels also increased significantly as the GOS score worsened. Levels of NE and E were significantly higher in patients who died or remained persistently vegetative than in those with better outcomes. In the 54 patients who survived beyond 1 week, significant correlations were present between the length of hospitalization and NE (r = 0.71, p < 0.0001) and E (r = 0.61, p < 0.0001) levels. Concentrations of NE (r = 0.61, p < 0.0004) and E (r = 0.48, p < 0.01) were also highly correlated with the duration of ventilatory assistance. Analysis of the interactions of CA levels and GCS scores, duration of ventilatory assistance, and length of hospitalization revealed that the CA's either enhanced the reliability of the GCS score or were independent predictors of outcome.

Thus, these findings indicate that alterations in circulating CA levels reflect the severity of the neurological insult and provide support for the use of CA measurements as a physiological marker of patient outcome in both the acute and chronic phases of traumatic brain injury.
Contribution of CSF and vascular factors to elevation of ICP in severely head-injured patients
Authors: Marmarou Anthony , Maset Angelo L. , Ward John D. , Choi Sung , Brooks Danny , Lutz Harry A. , Moulton Richard J. , Muizelaar J. Paul , DeSalles Antonio , Young Harold F.
Published: May 2009

✓ The authors studied the relative contribution of cerebrospinal fluid (CSF) and vascular parameters to the level of intracranial pressure (ICP) in 34 severely head-injured patients with a Glasgow Coma Scale score of less than 8. This was accomplished by first characterizing the temporal course of CSF formation and outflow resistance during the 5-day period postinjury. The CSF formation and outflow resistance were obtained from pressure responses to bolus addition and removal of fluid from an indwelling ventricular catheter. The vascular contribution to the level of ICP was assessed by withdrawing fluid at its rate of formation and observing the resultant change in equilibrium ICP level. It was found that, with the exception of patients with subarachnoid hemorrhage, CSF parameters accounted for approximately one-third of the ICP rise after severe head injury, and that a vascular mechanism may be the predominant factor in elevation of ICP.
Effect of subarachnoid hemorrhage on endothelium-dependent vasodilation
Authors: Nakagomi Tadayoshi , Kassell Neal F. , Sasaki Tomio , Fujiwara Shigeru , Lehman R. Michael , Johshita Hiroo , Nazar Gregory B. , Torner James C.
Published: May 2009

✓ The effect of subarachnoid hemorrhage (SAH) on endothelium-dependent vasodilation of the isolated rabbit basilar artery was examined using an isometric tension recording method. The SAH was induced by injecting 5 ml of fresh arterial blood into the cisterna magna. Sixty-two rabbits were separated into four groups according to the timing of sacrifice: control rabbits, and operated rabbits sacrificed on Days 2, 4, and 6 after SAH. Acetylcholine (ACh) (10−7 M to 10−4 M) and adenosine triphosphate (ATP) (10−7 M to 10−4 M) were used to evoke dose-dependent vasodilation of isolated arterial rings previously contracted by 10−6 M serotonin (5-HT). There were no significant differences in the vasodilatory response to ACh among these four groups. Relaxation to approximately 84% of the initial contractile tone occurred with 10−4 M ACh. On the other hand, the vasodilatory response to ATP was suppressed in the animals sacrificed 2 days after SAH; the relaxation of this group was approximately 52% at 10−4 M ATP, compared to a relaxation of 87% observed in the other groups of animals. One of the major causes of the impairment of endothelium-dependent vasodilation seems to be an inhibition of the production of endothelium-derived relaxing factor by endothelial cells.

After the relaxation studies, the dose-response curves for 5-HT were obtained. Serotonin caused significantly more contraction in the animals sacrificed 2 days after SAH than in the other groups. The present experiments suggest that impairment of the endothelium-dependent vasodilation following SAH, together with the potentiation of the contractile response to vasoactive agents in cerebral arteries, may play an important role in the pathogenesis of vasospasm.
Giant-cell tumor of the middle cranial fossa
Authors: Findlay J. Max , Chiasson David , Hudson Alan R. , Chui Mario
Published: May 2009

✓ The authors report the case of a 23-year-old man with a giant-cell tumor of the right middle cranial fossa floor. His presentation and management are described, and some aspects of this rare neoplasm of the skull base are reviewed. The role of adjuvant radiotherapy is discussed.
Paraplegia due to extramedullary hematopoiesis in thalassemia
Authors: Mann Kirpal S. , Yue Chung P. , Chan Kwan H. , Ma Lily T. , Ngan Henry
Published: May 2009

✓ Surgical excision followed by radiotherapy has been the recommended treatment for paraplegia due to extramedullary hematopoiesis in patients with beta-thalassemia. The authors report the successful treatment of such a case by partial excision and repeated blood transfusions.
Surgical management of large AVM's by staged embolization and operative excision
Authors: Spetzler Robert F. , Martin Neil A. , Carter L. Philip , Flom Richard A. , Raudzens Peter A. , Wilkinson Elizabeth
Published: May 2009

✓ A series of 20 patients with giant arteriovenous malformations (AVM's) managed with staged embolization and surgical resection is presented. Complete excision was accomplished in 18 of these patients. There were no deaths and only three complications, of which one was disabling. Further evidence for the presence of low perfusion surrounding the AVM, emphasizing the risk of normal perfusion pressure breakthrough, is provided by cortical perfusion pressure, cortical cerebral blood flow (CBF), and stable xenon computerized tomography CBF measurements.

The staged approach to giant AVM management is a proposed method to render AVM's that were previously considered inoperable or marginally operable into totally excisable lesions, while maintaining an acceptable level of morbidity and mortality.
Closure of extensive and complicated laminectomy wounds
Authors: Zide Barry M. , Wisoff Jeffrey H. , Epstein Fred J.
Published: May 2009

✓ Fifty-eight patients with previously irradiated intramedullary spinal cord astrocytomas underwent laminectomy for radical excision of their tumors. A high incidence of postoperative cutaneous cerebrospinal fluid fistulas and large pseudomeningoceles following routine closure prompted the development of an alternative method of wound closure using mobilized musculofascial flaps. The authors describe the surgical techniques and pitfalls to be avoided during the closure of complicated laminectomy wounds.
Effect of barbiturate coma on glucose utilization in normal brain versus gliomas
Authors: Blacklock J. Bob , Oldfield Edward H. , Di Chiro Giovanni , Tran Dung , Theodore William , Wright Donald C. , Larson Steven M.
Published: May 2009

✓ Glucose utilization by normal and neoplastic cerebral tissue can be measured in humans using positron emission tomography (PET) with fluorine-18-labeled 2-deoxy-D-glucose (FDG). Malignant gliomas are known to exhibit hypermetabolic glucose consumption compared to normal brain. Barbiturate-sensitive cerebral glucose utilization is coupled to neuronal activity, and lesions lacking neuronal activity should be relatively insensitive to barbiturate suppression of glucose utilization. In a study to examine this phenomenon, three patients with cerebral gliomas underwent FDG-PET while awake and during deep barbiturate coma. Cerebral glucose utilization was measured in normal brain, tumor, and a homologous, non-neoplastic control site in the contralateral hemisphere. A glucose utilization ratio for tumor/control tissue was calculated.

The mean reduction of glucose utilization during barbiturate coma was: gray matter 67%, white matter 47%, basal ganglia 66%, thalamus 57%, cerebellar cortex 55%, tumor 32%, and the contralateral control site 64%. The mean tumor glucose utilization ratio was 1.48:1 in the awake state and 2.69:1 during barbiturate coma. The changes in gray matter, basal ganglia, thalamus, cerebellar cortex, and tumor/control tissue ratio were significant (p < 0.05). In one patient, deep tumor invasion not evident on computerized tomography, magnetic resonance imaging, or baseline FDG-PET was apparent during barbiturate-enhanced FDG-PET scanning.

The study findings suggest that gliomas resist suppression of glucose utilization by barbiturates; this supports the hypothesis that barbiturates reduce neuronal metabolism by blocking synaptic activity. This differential effect on normal brain and gliomas enhances the capability to assess the extent of neoplastic tissue in brain and may represent the basis for novel therapeutic strategies.
Progressive ventricular enlargement in cats in the absence of transmantle pressure gradients
Authors: Shapiro Kenneth , Kohn Ira J. , Takei Futoshi , Zee Corinna
Published: May 2009

✓ Intracranial pressure (ICP) was measured simultaneously at multiple sites in cats to determine if transmantle pressure gradients were present in progressive hydrocephalus. The cats underwent craniectomy and intracisternal injection of kaolin; 4 to 9 weeks later ICP was measured at the ventricle, cisterna magna, and convexity subarachnoid space, and in the brain tissue and the sagittal sinus. In 13 cats in which ventricular size conformed to previously established norms for duration of hydrocephalus, there were no demonstrable gradients of pressure at any of the sites of measurement according to one-way analysis of variance (p > 0.05). The mean (± standard error of the mean) peak and trough pressures (in mm Hg) at each site were: ventricle, 12.7 ± 0.7 and 12.0 ± 0.6; cisterna magna, 12.9 ± 0.8 and 12.3 ± 0.7; subarachnoid space, 12.7 ± 0.8 and 12.1 ± 0.7; brain tissue, 12.9 ± 0.9 and 12.4 ± 0.9; and sagittal sinus, 13.1 ± 0.8 and 11.9 ± 0.8. These results indicate that ventricular expansion can progress without measurable transmantle pressure gradients.
Regulation of rCBF by intracortical vasoactive intestinal polypeptide-containing neurons
Authors: Itakura Toru , Yokote Hideyoshi , Okuno Takashi , Naka Yutaka , Nakakita Kazuo , Kamei Ichiro , Nakai Kunio , Imai Harumichi , Komai Norihiko
Published: May 2009

✓ The role of intracortical vasoactive intestinal polypeptide (VIP)-containing neurons in the regulation of cortical blood flow was investigated in rats by immunohistochemical and hydrogen clearance methods. Immunohistochemical studies revealed an intimate association between intracortical VIP-containing neurons and small blood vessels. Intracortical injection of a VIP solution (10−5 M) produced significantly higher blood flow in the treated cortex (mean ± standard error of the mean: 46.2 ± 4.0 ml/100 gm/min) than in the untreated cortex (36.9 ± 2.4 ml/100 gm/min). These data suggest that intracortical VIP-containing neurons produce dilatation of intracortical blood vessels.
Intracerebellar schwannoma
Authors: Sarkar Chitra , Mehta V. S. , Roy Subimal
Published: May 2009

✓ A rare case of a solitary schwannoma arising within the cerebellum is reported. The diagnosis was confirmed by electron microscopy and immunohistochemical staining.
Trigeminal nerve tumor: comparison of CT and MRI
Authors: Lye Richard H. , Ramsden Richard T. , Stack John P. , Gillespie James E.
Published: May 2009

✓ Benign tumors of the middle fossa components of the trigeminal nerve are rare. The authors describe the case history, radiological investigation, and operative findings of a patient with a large trigeminal neurofibroma of the middle fossa. The unusual mode of presentation is discussed. Valuable information was provided by magnetic resonance imaging prior to successful removal of this tumor.
A rapid and modifiable technique for regional exposure in cerebral surgery
Authors: Elisevich Konstantin V. , Colohan Austin R. T. , Brem Steven , Comair Youssef
Published: May 2009

✓ The authors describe a technique by which a properly demarcated regional cerebral exposure may be performed rapidly and safely. The method involves a linear scalp incision of varying length and orientation and a circumferential craniotomy of variable size and shape centered about a single burr hole. While providing for rapid exposure with reduced blood loss, the vascular integrity of the wound is also better preserved, allowing for rapid healing of the scalp. This technique provides satisfactory unilateral exposures of most cerebral sites not located in the vicinity of the frontal sinus or the sphenoid wing.
Cortical localization and monitoring during cerebral operations
Authors: King Robert B. , Schell Gerald R.
Published: May 2009

✓ Cortical sensory potentials have been evoked under general anesthesia by median nerve stimulation and direct cortical stimulation of the motor cortex in 35 consecutive patients with mass lesions in the middle half of the cerebral hemispheres. The evoked potentials produce movement that is useful in localizing the pre- and postcentral gyri. Ultrasound has also been used to aid in the selection of access routes to subcortical lesions while sparing the cerebral cortex bordering the rolandic fissure. In five of these 35 patients, the sensory evoked response was also monitored throughout selected portions of their operative procedures. Representative cases have been presented to illustrate how observations made with these methods have been used to facilitate the patient's intraoperative management in an effort to limit postoperative morbidity.
CT-stereotaxic drainage of colloid cysts in the foramen of Monro and the third ventricle
Authors: Mohadjer Mohsen , Teshmar Elemer , Mundinger Fritz
Published: May 2009

✓ Colloid cysts in the foramen of Monro and third ventricle account for 0.5% to 1% of all intracranial space-occupying lesions. The introduction of computerized tomography (CT) and magnetic resonance imaging has represented a major advance in the early detection of these cysts. The risks associated with the management of benign space-occupying lesions by open surgical procedures have made it necessary to search for safer techniques. The CT-stereotaxic method provides a simple, precise, and safe method of puncturing deep-seated space-occupying cysts. Between January, 1979, and December, 1984, 12 patients with colloid cysts in the foramen of Monro and third ventricle were operated on by this method. The operations were successful, and there were no intraoperative or postoperative complications. The advantages of the CT-stereotaxic method are discussed and the results are presented.
Statistical analysis of clinicopathological features, radiotherapy, and survival in 170 cases of oligodendroglioma
Authors: Lindegaard Karl-Fredrik , Mørk Sverre J. , Eide Geir E. , Halvorsen Tore B. , Hatlevoll Reidulv , Solgaard Torfinn , Dahl Olav , Ganz Jeremy
Published: May 2009

✓ The postoperative survival time of 170 nonrandomized patients treated for cerebral oligodendrogliomas in Norway from 1953 to 1977 was studied. Survival times were significantly prolonged if postoperative irradiation was performed in addition to surgery (median survival time 26.5 vs. 38 months, p = 0.039). In the group without postoperative radiotherapy, the 5-year rate of survival was 27% compared with 36% in the irradiated patients. The respective survival rates after 8 years were 14% versus 17%; thus, there was little effect on long-term survival. Irradiation appears not to be of benefit after “total” removal. Patients with partly resected lesions appeared to benefit from postoperative radiotherapy; the median survival period after subtotal tumor resection was 37 months with and 26 months without radiotherapy (p = 0.0089). The findings also indicate that irradiation doses between 40 and 50 Gy were as effective as doses between 50 and 60 Gy in increasing the patients' probability of surviving 5 years after subtotal tumor resection. Since the risk of radiation necrosis is proportional to the dose applied, the lower dose is recommended. These conclusions were also valid when adjustments were made for prognostically significant histological and clinical features.
Factors responsible for the retention of fluid in human tumor edema and the effect of dexamethasone
Authors: Bodsch Wolfram , Rommel Thomas , Ophoff Bernd Grosse , Menzel Jürgen
Published: May 2009

✓ The components of vasogenic edema associated with brain tumors were investigated in human biopsy material sampled from tumor and peritumoral tissue during neurosurgical operations. Tissue from 60 patients with glioblastomas, gliomas, meningiomas, and metastases who had been treated with dexamethasone prior to surgery was used for measurement of water, electrolyte, hemoglobin, serum protein, and dexamethasone concentrations. In all samples except metastases, positive correlations were obtained between water content and both serum protein levels and sodium content in tumors and peritumoral edema, suggesting that these components simultaneously determine forces for extravasation of plasma-derived edema fluid. However, the mean serum protein content varied considerably, being high in glioblastomas (16 mg/ml) and low in peritumoral edema surrounding metastases (4 mg/ml). The mean cerebral blood volume in all samples, as calculated from the tissue hemoglobin content, was 2.5 ml/100 gm wet weight in tumor tissue and 1.6 to 2.0 ml/100 gm wet weight in peritumoral tissue. Sodium concentrations were not significantly different among the tumor types. Both water and serum protein content decreased with increasing dexamethasone concentrations in glioblastomas, while this effect was virtually absent in gliomas and meningiomas. A therapeutic threshold of dexamethasone at 500 mg/gm wet weight was obtained for tumoral and peritumoral tissue of glioblastomas and was effective in a dose-dependent manner as long as the water content and the serum protein concentration remained below 6 ml/gm dry weight and 30 mg/gm dry weight, respectively. These results suggest a previously unknown selectivity among tumor types for the reduction of both water content and serum proteins in corticosteroid-treated edematous tissue.
Dissecting aneurysms of the anterior circle of Willis arteries
Authors: Kitani Ryuichi , Itouji Tooru , Noda Yatsugi , Kimura Makoto , Uchida Satoshi
Published: May 2009

✓ Two cases of spontaneous dissecting aneurysm extending from the supraclinoid portion of the internal carotid artery to the middle cerebral artery are reported in two teenaged patients. Both patients collapsed with a headache on the right side, left hemiparesis, and altered consciousness due to cerebral ischemia. One patient became alert in 2 days; however, his condition rapidly deteriorated 4 days later and he died on the 8th day from massive cerebral infarction. The other patient received a right superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis 50 hours after his initial symptoms. He improved gradually and is able to walk without help. Cerebral angiograms 3 months after the operation disclosed progressive attenuation of the MCA and dilatation of the anastomosed STA. Artificial collateral flow demonstrated in the postoperative angiogram may have been useful in preventing massive cerebral infarction.
A combined neurilemmoma and angioma of the parasellar region
Authors: Kasantikul Vira , Shuangshoti Samruay , Preechayudh Pornyudh , Wangsuphachart Somjai
Published: May 2009

✓ A combined neurilemmoma and angioma of the parasellar region is presented that clinically simulated a pituitary tumor. The lesion produced increased intracranial pressure and subarachnoid hemorrhage (SAH). This neoplasm is believed to have originated from the leptomeninges or the perivascular neural elements, or both. The angiomatous network within the tumor could have been the source of the SAH.
Long-term results of surgically treated congenital intradural spinal arachnoid cysts
Authors: Alvisi Carlo , Cerisoli Marziano , Giulioni Marco , Guerra Lorenzo
Published: May 2009

✓ The authors report long-term results in 17 patients with surgically treated congenital intradural spinal arachnoid cysts. Comparison between the immediate and long-term results demonstrates that surgical removal of the cyst allowed a significant neurological improvement in all cases, but clinical worsening of various degrees was observed later. The authors attempt to explain the results in terms of mechanical and vascular factors.
Cervical spine stenosis secondary to ossification of the posterior longitudinal ligament
Authors: Harsh Griffith R. , Sypert George W. , Weinstein Philip R. , Ross Donald A. , Wilson Charles B.
Published: May 2009

✓ Ossification of the posterior longitudinal ligament (OPLL) is a well-documented cause of cervical spine stenosis and myelopathy among Japanese patients. Reports of OPLL in North Americans are rare. Choices of diagnostic method and treatment for this entity remain controversial. The authors report the results of management of 20 patients in the United States with symptomatic OPLL of the cervical spine. These represented 10% to 20% of patients operated on over the last 3 years for myelopathy secondary to structural spinal compression. Most of these OPLL patients were Caucasian (60%), male (male:female 4:1), and middle-aged (median age 47.5 years). Six had previously undergone laminectomy or discectomy. Cervical roentgenograms and standard myelography occasionally suggested the diagnosis. Axial computerized tomography (CT) metrizamide myelography with small interslice intervals proved invaluable for diagnosis and operative planning. Magnetic resonance imaging was not necessary for diagnosis. Retrovertebral calcification extended over one to five bodies (mean 2.75). The mass ranged in size from 5 to 16 mm in anteroposterior diameter and reduced the residual canal diameter to a mean (± standard deviation) caliber of 9.42 ± 2.41 mm (mean narrowing ratio 0.44 ± 0.12).

Anterior cervical decompression by medial corpectomy and discectomy with fusion uniformly reduced preoperative myelopathy. Complications were limited to transient neurological deterioration in two patients, recurrent laryngeal nerve palsy in one, and halo device pin site infections in two. At a mean postoperative interval of 15 months, improvement was seen in each category of deficit: extremity weakness, hypesthesia, hypertonia, and urinary dysfunction. All fusions produced solid unions.

It is concluded that OPLL of the cervical spine is an unexpectedly prevalent cause of myelopathy among patients treated in the United States. Thin-section axial CT metrizamide myelography with small interslice intervals is essential for the investigation of patients who may have OPLL. Anterior decompression and stabilization by medial corpectomy, discectomy, removal of the calcified mass, and fusion is a safe and effective method of treatment.
C-Reactive protein levels in the differential diagnosis of brain abscesses
Authors: Hirschberg Henry , Bosnes Vidar
Published: May 2009

✓ C-reactive protein (CRP) is a protein found in plasma at elevated concentrations during acute or chronic infections. As an aid in the differential diagnosis between brain tumor and abscess, the CRP levels were measured in 20 patients with intracranial mass lesions and the appearance of ring-like contrast enhancement on computerized tomography (CT) scans. In nine of these patients, the final diagnosis was abscess, based on either biopsy of the mass (eight patients) or the clinical course (one patient). In seven of the nine patients, there was a significant increase in CRP levels in two consecutive measurements. In particular, patients with cerebritis who were examined early in the course of the disease and who showed nonspecific CT scans exhibited extremely high levels of CRP. Two patients had no measurable CRP activity although they both had brain abscesses. In 12 patients harboring either gliomas or metastatic intracerebral tumors, CRP levels were significantly lower than those found in patients with brain abscesses but were nevertheless higher compared to those of a group of patients with benign tumors. It is concluded, therefore, that the measurement of CRP can have some value in the differential diagnosis between brain abscess and brain tumor. The measurement technique is inexpensive and is available in the clinical laboratories of most hospitals with a neurosurgical department.
Pressure-volume index as a function of cerebral perfusion pressure
Authors: Gray W. John , Rosner Michael J.
Published: May 2009

✓ The pressure-volume index (PVI) was measured as a function of cerebral perfusion pressure (CPP) in 12 adult cats. Anesthesia was induced with methohexital in six animals and with pentobarbital in six animals; all were maintained on an N2O:O2(70%:30%) mixture. The CPP was either increased in 10-torr increments using norepinephrine or decreased by a combination of adenosine triphosphate and hemorrhage in subgroups. Three estimations of PVI were made at each level of CPP. The PaCO2, body temperature, and hematocrit were controlled at normal levels throughout. In both groups there was a linear relationship between PVI and CPP with increasing CPP being reflected by a rise in PVI. This relationship was more marked in the methohexital group: PVI = 0.37 ml + 0.0005 mm Hg CPP in the pentobarbital group, and PVI = 0.14 ml + 0.0019 mm Hg CPP in the methohexital group. These results indicate that the PVI is not independent of CPP but is a function of CPP and is profoundly influenced by anesthesia.
Recombinant human tissue-type plasminogen activator therapy in acute thromboembolic stroke
Authors: Papadopoulos Stephen M. , Chandler William F. , Salamat M. Shahriar , Topol Eric J. , Sackellares J. Chris
Published: May 2009

✓ Systemic fibrinolytic therapy for acute stroke is no longer recommended because of resulting systemic fibrinolysis and the risk of intracerebral hemorrhage. Human tissue-type plasminogen activator (TPA) is a native enzyme that converts plasminogen to plasmin with subsequent clot lysis. The affinity for plasminogen is increased several-fold when the substrate is bound to fibrin. At appropriate dosage, “clot-specific” throm-bolysis may be achieved at the surface of the thrombus without creating systemic fibrinolysis.

The authors designed a study to evaluate the effect of intravenous TPA administered 2 hours after acute thromboembolic stroke in rats. This time course was chosen to simulate an analogous clinical situation. Middle cerebral artery embolic stroke was caused by intracarotid injection of 0.025 cc of human blood clot in 16 rats. Regional cerebral blood flow, measured by the hydfogen clearance technique, and electroencephalographic (EEG) recordings were obtained every 30 minutes for 5 hours after thromboembolism. Eight rats received a 1-hour infusion of intravenous TPA (1.5 mg/kg) 2 hours after injection of emboli. Ipsilateral blood flow increased significantly within 30 minutes after intravenous TPA and reached preembolic levels within 60 minutes. Blood flow did not improve in the eight control rats throughout the experiment. Power spectral analysis of the EEG recordings showed improvement in the treated group compared to the control group. Postmortem angiography revealed proximal middle cerebral artery occlusion in control animals and patent middle cerebral arteries in TPA-treated animals. Serum fibrinogen and fibrin split products were unchanged in both groups, indicating the absence of systemic fibrinolysis. There were no intracerebral hemorrhages.

It is concluded that, in this rat model, TPA increases blood flow with subsequent improvement in the EEG recording after thromboembolic stroke without evidence of systemic fibrinolysis. Intravenous TPA may be useful in the treatment of acute stroke in man.
Effect of dihydropyridines and diphenylalkylamines on pentylenetetrazol-induced seizures and cerebral blood flow in cats
Authors: Ots Max E. , Yaksh Tony L. , Anderson Robert E. , Sundt Thoralf M.
Published: May 2009

✓ Nimodipine, a dihydropyridine that interacts with a Ca++ channel-associated binding site, when delivered (30 to 150 µg/kg) intra-arterially (ia) to enflurane-anesthetized cats, produced a dose-dependent suppression of seizures evoked by pentylenetetrazol. A comparable suppression was produced by clonazepam (1 to 30 µg/kg, ia). Phenytoin was maximally effective only at nearly lethal doses (90 mg/kg, ia). Verapamil, a diphenyl-alkylamine that interacts with a separate Ca++ channel-associated site, at the maximum nonlethal dose (6 mg/kg, ia) resulted in a mild facilitation of seizure activity. The drug vehicle used in these studies (50% polyethylene glycol-400) had no effect when given alone. Regional cerebral blood flow (rCBF) as measured by the clearance of xenon-133 was markedly elevated immediately after the onset of seizure activity (89 ± 3 to 168 ± 4 ml/100 gm/min). Concurrent with their resolution of the seizure activity, both nimodipine and clonazepam reduced rCBF to near preseizure levels and preserved the rCBF response to hypercarbia which would otherwise have been abolished following prolonged seizure activity. Moreover, the effect of nimodipine on rCBF and seizures occurred without any prominent alterations in mean arterial blood pressure as compared to preseizure levels. These data support the proposition that a dihydropyridine Ca++ channel binding site may play a role in modulating paroxysmal neuronal activity, and suggest that this class of agents may reflect a novel group of antiepileptic drugs.
Desmoplastic fibroma of parietal bone simulating eosinophilic granuloma
Authors: Hufnagel Thierry J. , Artiles Carlos , Piepmeier Joseph , Kier Leon , Kim Jung H.
Published: May 2009

✓ Desmoplastic fibroma is a distinctive and rare neoplasm of bone. Only one previous example has been reported in the calvaria. The diagnostic and surgical aspects of a case of desmoplastic fibroma of the skull that radiographically simulated eosinophilic granuloma are reported.
Metameric capillary hemangioma producing complete myelographic block in an infant
Authors: Mawk John R. , Leibrock Lyal G. , McComb Rodney D. , Trembath Edmund J.
Published: May 2009

✓ A variety of lesions of ectodermal, mesodermal, (rarely) endodermal, or mixed-cell layer origin involve the region of the conus medullaris. Some of these abnormalities produce cord tethering and others, such as lipoma, frequently present as masses. In the present case, an infant was discovered to have a lesion most closely resembling a capillary hemangioma involving the skin of the midline and right buttock, the deep soft tissues of the right buttock, the dura, and the conus medullaris. The origin of this congenital spinal tumor from primitive mesoderm is proposed in light of its metameric pattern of distribution.
Preservation of the frontotemporal branch of the facial nerve using the interfascial temporalis flap for pterional craniotomy
Authors: Yaşargil M. Gazi , Reichman Mark V. , Kubik Stefan
Published: May 2009

✓ The pterional craniotomy as described previously by the first author requires creation of a special flap over the temporalis muscle for increased visibility. Topographical variations of the course taken by the frontal branches of the facial nerve were studied and are described in this report.
Intra-axial tumors of the cervicomedullary junction
Authors: Epstein Fred , Wisoff Jeffrey
Published: May 2009

The authors present their experience with the operative management of 20 intra-axial tumors of the cervicomedullary junction. There were two distinct modes of clinical presentation: lower cranial nerve dysfunction and spinal cord dysfunction. Both groups of patients had indolent courses: in 75% of the patients the symptoms had been present for 6 months to 2 years. Radical excision was carried out in all patients. There was no surgical mortality. Postoperative neurological recovery was directly related to the preoperative status; one patient had a significant new deficit. The authors conclude that intrinsic gliomas of the cervicomedullary junction are amenable to radical excision and that an aggressive surgical approach offers the potential for both neurological recovery and long-term survival. The neuroradiological evaluation and operative technique are discussed.
Monitoring of 57Co-bleomycin delivery to brain metastases and their tumors of origin
Authors: Front Dov , Even-Sapir Einat , Iosilevsky Galina , Israel Ora , Frenkel Alex , Kolodny Gerald M. , Feinsud Moshe
Published: May 2009

✓ The concentration of cobalt-57 (57Co)-labeled bleomycin delivered to three brain metastases and to their tumors of origin in the lungs was measured using a single-photon emission computerized tomography technique. In two brain metastases the 57Co-bleomycin concentration measured at different times after the intravenous injection was significantly lower than that in the originating lung tumors (p < 0.01 and p < 0.001). In these two patients, the tumor cumulative concentration (TCC) of drug in the brain neoplasm compared to the lung carcinoma was 12.92 versus 15.12 and 10.30 versus 19.74 µg/cc/min. In the third patient there was no significant difference in drug concentration between the tumor in the brain and in the lung (TCC 16.02 vs. 15.09 µg/cc/min). There was a significant difference in the drug TCC between the three brain metastases: the difference between the lowest and highest concentrations was more than 50% (10.3 vs. 16.02 µg/cc/min). When the concentration in the tumor over time (CT(t)) of the 57Co-bleomycin was compared in the brain and lung tumors, a good correlation was found in each of the three cases (r = 0.93, 0.99, and 0.97). This suggests that the difference in drug uptake between brain metastases and their originating lung tumor is a quantitative rather than a qualitative phenomenon. The results show that the amount of drug to which brain metastases are exposed varies and may be very low in some tumors; therefore, effectiveness of drug delivery may play a role in the nonresponsiveness of brain metastases to treatment.
Surgical approaches to trigonal arteriovenous malformations
Authors: Batjer Hunt , Samson Duke
Published: May 2009

✓ Only about 5% of intracranial arteriovenous malformations (AVM's) are located predominantly within the ventricular system. Between July, 1981, and February, 1986, 15 patients were treated at the authors' institution for AVM's within the ventricular trigone. The mean age of this patient population was 24 years, and two-thirds were female. Intracranial hemorrhage was by far the most frequent presenting symptom and intraventricular hemorrhage occurred in 11 cases, with multiple episodes being documented in five. Arterial supply of the malformations was quite uniform, with the lateral posterior choroidal or posterior temporal branch of the posterior cerebral artery (PCA) being the most frequent source. Venous drainage was similarly stereotypic, with predominant outflow into the galenic system in all but one patient. An interhemispheric surgical approach was used in eight patients, a middle or inferior temporal gyrus incision was performed in six, and a subtemporal route was chosen in a single patient. Operative results suggest that these lesions can be removed with reasonable safety. An interhemispheric approach is recommended if the nidus projects medially from the trigone and is observed medial to the P2-P3 junction of the PCA on angiography. A middle temporal gyrus approach is suggested if the nidus is lateral to the P2-P3 junction, even when the lesion is located in the dominant hemisphere. A subtemporal approach should be reserved for inferiorly projecting AVM's with cortical representation on the fusiform or parahippocampal gyrus in the nondominant hemisphere.
Relationships between intracranial pressure, ventricular size, and resistance to CSF outflow
Authors: Børgesen Svend E. , Gjerris Flemming
Published: May 2009

✓ In 230 patients with normal-pressure hydrocephalus, high-pressure hydrocephalus, or benign intracranial hypertension, measurements of the intracranial pressure (ICP), ventricular size, and cerebrospinal fluid (CSF) outflow resistance (Ro) have revealed a linear relationship between ICP and Ro. It is shown that on average the CSF formation rate tends to decrease with increasing ICP. It is also shown that the size of the ventricles increases as the ICP levels off toward normal values. The clinical implication of this is that a small or normal ventricular size in acute or subacute phases does not preclude defective CSF resorption.
A prospective analysis of 142 carotid endarterectomies for occlusive vascular disease, 1979–1985
Authors: Zeiger H. Evan , Zampella Edward J. , Naftel David C. , McKay Robert D. , Varner Pamela D. , Morawetz Richard B.
Published: May 2009

✓ Carotid endarterectomy may carry a substantial risk of morbidity and mortality from major stroke, thus offsetting any statistical benefit in reduction of future stroke. Because of the disturbing ranges in the incidence of stroke morbidity and mortality reported from the several institutional series studying carotid endarterectomy, the authors undertook a prospective review of 142 consecutive carotid endarterectomies performed for symptomatic atherosclerotic occlusive vascular disease on the neurosurgical service, The University of Alabama Hospital. Preoperative risk assessment was performed in each case according to the Mayo Clinic classification system. The overall mortality rate was 1.4% and the major stroke morbidity rate was 0.7%, for a combined major morbidity and mortality rate of 2.1%. The incidence of minor neurological morbidity was 1.4%. There was no morbidity or mortality in the Grade I and II (low-risk) patient groups. This low combined major morbidity and mortality rate of 2.1% for carotid endarterectomy causes the surgical stroke-free survival curve to intersect the medical stroke-free survival curve at an earlier point in time, and thus demonstrates the greater reduction in risk of stroke which accrues over time for the surgically treated patient.
Primary cerebellar hemorrhage
Authors: Taneda Mamoru , Hayakawa Toru , Mogami Heitaro
Published: May 2009

✓ The authors studied a consecutive series of 75 patients with cerebellar hemorrhage diagnosed by computerized tomography (CT) scanning, and assessed the relationship of outcome to the CT appearance of the quadrigeminal cistern, which in some cases was obliterated by rostral displacement of the vermis resulting from the cerebellar mass. Obliteration of the quadrigeminal cisterns was classified on the CT scans into three grades: normal (Grade I), compressed (Grade II), or absent (Grade III). There were 43 patients with Grade I, 16 with Grade II, and 16 with Grade III cisterns. Of the 75 patients, 38 (88.4%) of those with Grade I, 11 (68.8%) of those with Grade II, and none of those with Grade III cisterns returned to their previous activities at 6 months or more after onset. A Grade I cistern predicted a good outcome whether the hematoma was evacuated or not, as long as obstructive hydrocephalus, if present, was relieved early. However, a Grade II cistern was not predictive of a good outcome unless the hematoma was evacuated within 48 hours after onset of the hemorrhage. A Grade III cistern invariably predicted an unfavorable outcome. It is concluded that the CT grade of quadrigeminal cistern obliteration is an accurate indicator of outcome and is highly useful in selecting appropriate treatment for patients with cerebellar hemorrhage.