bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary intracranial germ-cell tumors
Authors: Shokry Ali , Janzer Robert C. , Hochstetter Arthur R. Von , Yaşargil Mahmut Gazi , Hedinger Christoph
Published: May 2009

✓ Fourteen cases of primary intracranial germ-cell tumors are presented. Histologically, there were eight germinomas, three teratomas, and three germ-cell tumors of more than one histological type. Immunohistochemical studies revealed alpha-fetoprotein in yolk-sac tumor components in two cases and beta human choriogonadotropin in syncytiotrophoblastic giant cells in one case. One teratoma contained an unusual pleomorphic sarcomatous portion with features of early myoblastic differentiation. Comparison of intracranial with gonadal germ-cell tumors shows that the same subtypes are found in both locations with comparable incidence and similar biological behavior. The detailed World Health Organization classification of testicular germ-cell tumors should be applied to the histopathological classification of intracranial germ-cell tumors. Despite the critical location of intracranial germ-cell tumors, a good outcome can be achieved by optimal surgical excision. A primary microsurgical approach provides a histopathological diagnosis, which is indispensable for the proper choice of postoperative management.
Localization of carcinoembryonic antigen in mature intracranial teratomas
Authors: Naganuma Hirofumi , Inoue Hiroshi K. , Nakamura Masaru , Koizumi Hidehito
Published: May 2009

✓ Carcinoembryonic antigen (CEA) in serum and cerebrospinal fluid (CSF) was measured in four patients with intracranial teratoma. The CEA levels were elevated in the CSF of two patients, but were within normal limits in the serum of all four. After surgical removal of the teratomas, which were verified as mature teratomas, CEA was localized by an immunohistochemical method. Positive reactions both to anti-CEA serum and to another anti-CEA serum absorbed with nonspecific cross-reacting antigen were seen in glandular structures, with or without goblet cells, and in some portions of stratified squamous epithelium. It is concluded that CEA, detected in CSF, may originate in mature teratomas, and CEA-positive structures (especially glandular) may differentiate into gastrointestinal tract structures. An examination of serum and CSF levels of CEA may offer additional clues to the diagnosis of intracranial germ-cell tumors.
High-dose glucocorticoid treatment improves neurological recovery in head-injured mice
Authors: Hall Edward D.
Published: May 2009

✓ The ability of a single large intravenous dose of the sodium succinate esters of the glucocorticoids methylprednisolone, prednisolone, or hydrocortisone to enhance early neurological recovery after moderate to severe blunt head injury was examined in male CF-1 mice. Unanesthetized mice were restrained and subjected to a 900 gm-cm head injury produced by a 50-gm weight dropped 18 cm. This injury resulted in immediate loss of consciousness (loss of the righting reflex) in all animals, and death in approximately 30%. Survivors received a 0.1-ml tail vein injection of either vehicle or 15, 30, 60, or 120 mg/kg of methylprednisolone, prednisolone, or hydrocortisone within 5 minutes. Their neurological status was evaluated at 1 hour after injury. A 30-mg/kg dose of methylprednisolone was found to improve recovery significantly in comparison to that seen in vehicle–treated mice. A 15-mg/kg dose was less effective, and a 60- or 120-mg/kg dose was essentially ineffective. Prednisolone was also observed to improve neurological scores at 1 hour postinjury. A 60-mg/kg dose of prednisolone was optimal, while lower and higher doses had no effect. Hydrocortisone was unable to improve recovery over the wide dose range tested. The implications of these findings for the clinical management of head injury with glucocorticoid steroids are discussed.
Loss of auditory function in microvascular decompression for hemifacial spasm
Authors: Møller Margareta B. , Møller Aage R.
Published: May 2009

✓ Auditory function was studied before and after surgery in 143 consecutive patients who were operated on for hemifacial spasm by microvascular decompression of the intracranial portion of the facial nerve. The acoustic middle ear reflex was abnormal preoperatively in 41% of the patients, indicating that the vascular abnormalities that caused the hemifacial spasm also affected the auditory nerve. Three patients suffered a profound hearing loss in the ear on the operated side, and one lost hearing function totally. In addition, 24 patients had a moderate elevation in the pure-tone threshold at one or more octave frequencies. Of these, 16 patients experienced a hearing loss at only one frequency (8000 Hz), while eight had a threshold evaluation of no more than 20 dB in the speech frequency range (500, 1000, and 2000 Hz). Two patients were deaf on the side of the spasm before the operation. Three patients were not tested postoperatively, and one patient was tested only after surgery. Thus, in this series of 143 patients, only 2.8% suffered a significant hearing loss as a complication of facial nerve decompression to relieve hemifacial spasm.
Experimental feline hydrocephalus
Authors: Shapiro Kenneth , Takei Futoshi , Fried Arno , Kohn Ira
Published: May 2009

✓ In a craniectomy-durectomy model of kaolin-induced feline hydrocephalus, the pressure-volume index (PVI) technique of bolus manipulations of cerebrospinal fluid (CSF) was used to study the biomechanical changes associated with hydrocephalus. Steady-state intracranial pressure (ICP), PVI, and the resistance to the absorption of CSF were determined acutely and 3 to 5 weeks later in hydrocephalic cats and time-matched control cats. Steady-state ICP was 11.0 ± 2.1 mm Hg (± standard deviation) in the hydrocephalic cats, compared to 10.8 ± 2.2 mm Hg in the chronic control group (p > 0.1). The ICP in both the chronic hydrocephalic and chronic control groups was significantly higher (p < 0.001) than after acute durectomy (mean ICP 8.5 ± 1.2 mm Hg). Immediately after dural opening, the mean PVI was 3.6 ± 0.2 ml (± standard error of the mean); over time, it decreased to 1.3 ± 0.1 ml in the chronic control group (p < 0.001), but remained elevated in the hydrocephalic group at 3.5 ± 0.4 ml (p < 0.001). Resistance to CSF absorption was 9.1 ± 1.4 mm Hg/ml/min immediately after dural opening and increased to 28.8 ± 4.5 mm Hg/ml/min (p < 0.001) in the hydrocephalic cats; it increased even further in the chronic measurements in control cats, to 82.3 ± 9.2 mm Hg/ml/min (p < 0.001). Ventricular size was moderate to severely enlarged in all hydrocephalic cats, and normal in the control group.

These results indicate that the biomechanical profile of the altered brain container model of kaolin-induced feline hydrocephalus resembles that described in hydrocephalic infants. As shown in the control subjects, an absorptive defect alone is not sufficient to cause progressive ventricular enlargement. Increased volume-buffering capacity coupled with a moderate increase of CSF absorption resistance facilitates volume storage in the ventricles.
Suprasellar peri-infundibular ectopic adenohypophysis in fetal and adult brains
Authors: Hori Akira
Published: May 2009

✓ Ectopic anterior pituitary cells, identified by histological, electron microscopic, and immunohistochemical methods, were consistently found in the leptomeninges of the suprasellar peri-infundibular region of fetal brains. The cell groups were not in continuity with the pars tuberalis of the adenohypophysis. Suprasellar peri-infundibular ectopic pituitary cells, which snowed no neoplastic character, were found in 15 of 20 “normal” adult brains that were similarly examined. This finding sheds new light on the possible origin of intracranial ectopic pituitary adenomas.
Reduction of blood flow in the adenohypophysis of rats by bromocriptine
Authors: Kemeny Andras A. , Jakubowski Jan A. , Pasztor Emil , Jefferson Anthony A. , Wojcikiewicz Richard
Published: May 2009

✓ The possibility that bromocriptine has a selective effect on blood flow in the adenohypophysis was examined in rats. Twenty-four anesthetized male Wistar rats underwent measurement of blood flow using the hydrogen clearance method. Intravenous injection of 50 µg/kg bromocriptine reduced the blood flow in both the medial and lateral parts of the adenohypophysis to about 70% of the baseline value. Simultaneously measured cerebral cortical and white matter flows were unchanged. Similar results were obtained following administration of a higher dose (500 µg/kg) of bromocriptine. This phenomenon cannot be attributed to the decrease in blood pressure. The course of change in blood flow in the medial and lateral adenohypophysis did not follow that of the mean arterial blood pressure, and the alteration of blood pressure remained within the limits of autoregulation in the adenohypophysis. The results indicate that bromocriptine is capable of reducing blood flow selectively in the pituitary region. This mechanism may contribute to the clinical usefulness of this drug.
Intrathecal phenol and glycerin in metrizamide for treatment of intractable spasms in paraplegia
Authors: Scott Brett A. , Weinstein Zelig , Chiteman Robert , Pulliam Morris W.
Published: May 2009

✓ Intractable lower extremity spasms after spinal cord injury is a significant source of morbidity. A case of refractory spasticity in paraplegia was successfully converted to flaccid paraplegia by intrathecal injection of phenol and glycerin in metrizamide. This chemical rhizolysis is simple and effective, and the presence of metrizamide allows both fluoroscopic guidance for accurate intrathecal phenol placement and good miscibility with cerebrospinal fluid. A brief comparative review of alternative therapeutic modalities is presented.
Actinomycosis of the brain
Authors: Chen-wei He
Published: May 2009

✓ A rare case of actinomycosis of the brain is reported. The patient recovered after surgical excision of the lesion and a prolonged course of antibiotic therapy. At follow-up examination 25 months later, the patient was in excellent health. Different types of actinomycotic infections of the central nervous system are reviewed and the diagnosis and treatment of this disease are discussed.
Unilateral subdural-peritoneal shunting for bilateral chronic subdural hematomas in infancy
Authors: Aoki Nobuhiko , Mizutani Hiroshi , Masuzawa Hideaki
Published: May 2009

✓ The authors present the cases of three infants with bilateral chronic subdural hematomas (SDH's) (effusions). Communication between the hematoma cavities was confirmed by an injection of air or metrizamide into one of the cavities. In all three cases, both SDH's (effusions) were successfully treated by placement of a unilateral subdural-peritoneal shunt without any untoward consequences. It is stressed that the cavities of bilateral chronic SDH's (effusions) may communicate, and that in such cases unilateral subdural-peritoneal shunting is sufficient to eradicate the SDH's on both sides. In addition, subdural fluid, even with a high protein concentration, may be successfully eliminated by an internal shunt using a shunt tube with a large internal caliber and a low-pressure valve.
Arteriovenous malformations of the lateral ventricle
Authors: Waga Shiro , Shimosaka Shinichi , Kojima Tadashi
Published: May 2009

✓ Nine cases with arteriovenous malformations (AVM's) predominantly involving the lateral ventricle are presented. All the AVM's were small, but caused intraventricular hemorrhage in eight cases. Only two patients had an intracerebral hemorrhage large enough to warrant evacuation. Eight patients were under the age of 40 years at the onset of their disease. Computerized tomography demonstrated intraventricular hemorrhage in eight patients, and after intravenous administration of contrast medium a small area of enhancement with dilated subependymal draining veins was seen in seven. The lateral ventricles were of normal size in seven cases, and only two patients required a shunting procedure. Angiography demonstrated that the lesion was an AVM in eight patients, and did not visualize the lesion in the ninth. One patient suffered a recurrent intraventricular hemorrhage when the AVM was demonstrated, although repeated angiography had failed to disclose a vascular lesion at his first intraventricular hemorrhage 14 months before.

All nine lesions were resected by microsurgical techniques, and the results were excellent in eight patients. Of four caudate lesions, three were resected through a frontal transcortical approach and the other was operated on through an anterior transcallosal approach; the results were excellent in three of these patients. Only one (Case 4) was left with neurological deficits; he had confusion and disorientation following a right frontal transcortical approach. Even in the dominant hemisphere, lesions in the head of the caudate nucleus could be safely resected by an anterior transcallosal approach. Two choroidal lesions located in the temporal horn and trigone on the dominant side were resected through a middle temporal gyrus approach, and three thalamic lesions through a posterior transcallosal approach, all with excellent results. In all cases the brain opening required was about the width of the retractor (maximum 2.0 cm, average 1.5 cm).
Post-decompression optic neuropathy
Authors: Beck Roy W. , Greenberg Harry S.
Published: May 2009

✓ Blindness resulting from a decompressive craniotomy is uncommon. Five patients with intracranial tumors and papilledema who developed a bilateral optic neuropathy during an apparently uncomplicated craniotomy are presented. Symptoms of visual field loss were minimal preoperatively in four. Visual recovery in general was poor. The nerve fiber bundle pattern of visual field loss in these cases implicates the optic disc as the site of damage in this disorder. It is postulated that hypoperfusion to the prelaminar portion of the optic nerve is the underlying cause.
Infratentorial arachnoid cysts
Authors: Galassi Ercole , Tognetti Francesco , Frank Franco , Fagioli Leo , Nasi Maria Teresa , Gaist Giulio
Published: May 2009

✓ The infratentorial compartment represents the second most common location of arachnoid malformations. Ten arachnoid cysts of the posterior fossa, operated on between 1970 and 1983, are reviewed. These lesions, although congenital and developmental in nature, may present at any age, and males are more frequently affected. A high rate of birth-related trauma (50% in this series) is conceivably due to fetal macrocranium, and the enlarged head and psychomotor retardation prevail in infancy and childhood. In arachnoid cysts occurring during adulthood, symptoms and signs more clearly indicate a dysfunction of the posterior fossa.

Besides computerized tomography, pneumoencephalography and metrizamide techniques are recommended to rule out a Dandy-Walker syndrome in doubtful cases, and to obtain information about the cerebrospinal fluid (CSF) circulation. It is particularly important to establish the presence and type of communication of cysts with the CSF pathways. Although infratentorial cysts often communicate, they can be space-occupying masses because of increasing CSF retention, which may be due to a ball-valve mechanism or to inadequate communication. The frequently associated hydrocephalus (seven of the 10 cases in this series had hydrocephalus) seemed to be dependent mainly upon mechanical factors. The authors discuss the indications for intracranial surgery versus shunting procedures and report the results achieved by direct cyst excision.
Phase III comparison of BCNU and the combination of procarbazine, CCNU, and vincristine administered after radiotherapy with hydroxyurea for malignant gliomas
Authors: Levin Victor A. , Wara William M. , Davis Richard L. , Vestnys Pamela , Resser Kenneth J. , Yatsko Kathleen , Nutik Stephen , Gutin Philip H. , Wilson Charles B.
Published: May 2009

✓ The authors report the results of a randomized study conducted to evaluate the relative benefit of treatment with 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) or the combination of procarbazine, 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea, and vincristine (PCV) administered after radiation therapy with hydroxyurea to 76 evaluable patients with glioblastoma multiforme and 72 patients with other anaplastic gliomas. The primary end-point of the study was time to tumor progression. For better-risk patients with Karnofsky performance scores of 70 to 100, results suggest that PCV was of greater benefit than BCNU (p = 0.15 for glioblastoma multiforme; p = 0.13 for other anaplastic gliomas). Median times to tumor progression were 31 and 32 weeks for patients with glioblastoma multiforme; 25th percentile times to progression were 70 and 40 weeks for patients treated with PCV and BCNU, respectively. For patients with other anaplastic gliomas treated with PCV and BCNU, median times to progression were 123 and 77 weeks, respectively. Multivariate analysis showed that the prognostic variables of age and Karnofsky scores were important for patients with glioblastoma multiforme and other anaplastic gliomas, and that the extent of surgical resection was important for those with other anaplastic gliomas.
Sensory and motor responses to deep brain stimulation Correlation with anatomical structures
Authors: Namba Shimpei , Wani Takao , Shimizu Yoji , Fujiwara Noriaki , Namba Yoichiro , Nakamua Shigeo , Nishimoto Akira
Published: May 2009

✓ Motor and sensory responses induced by trial stimulation were examined before stereotaxically implanting a permanent stimulating electrode for pain relief in 11 patients with intractable pain of central origin. The total number of points eliciting a response when stimulated was 70. The points of stimulation were determined as exactly as possible from Schaltenbrand and Bailey's Atlas. Motor responses were detected upon stimulating 21 points, the majority of which were in the posterior third of the posterior limb of the internal capsule (IC). Stimulation of these 21 points was accompanied by pain relief in only two points (10%). Warm (22) or cool sensations (three) were provoked in the most posteromedial portion of the posterior limb of the IC, nucleus reticularis pulvinaris, and area triangularis, and seven (28%) of these 25 sensations were accompanied by pain relief. A burning sensation was found upon stimulation of 12 points, with stimulation in the mesencephalic lateral tegmental field eliciting the most severe burning pain. A tingling sensation was elicited at 12 points, in a distribution similar to that of the warm sensation. Five (42%) of these 12 points provided pain relief. The best stimulating point for pain relief is not in the center of the posterior limb of the IC, directly lateral to the posterior commissure, but rather in its most posteromedial part; that is, at the nucleus reticularis pulvinaris or area triangularis.
Pituitary apoplexy in an acromegalic patient during bromocriptine therapy
Authors: Alhajje Antoine , Lambert Michel , Crabbé Jean
Published: May 2009

✓ The authors report a case of pituitary apoplexy that developed in a patient shortly after bromocriptine therapy was started for a growth hormone-secreting pituitary adenoma. The tumor was associated with visual impairment and ocular palsies, and was treated by transsphenoidal decompression. Although spontaneous tumor necrosis cannot be excluded, a causal role of bromocriptine treatment is suggested.
A self-retaining multipore suction tube
Authors: Nishizaki Tomoyuki , Wakabayashi Toshimitsu
Published: May 2009

✓ A new self-retaining multipore suction tube with three unusual features is described. The features are: 1) multiple 0.5 mm suction openings; 2) a variable suction control; and 3) a device for fixation to a self-retaining retractor.
Cushing Oration, 1985: From space exploration to utilization of the space perspective, environment, and materials
Authors: Arvidson Raymond E.
Published: May 2009

✓ As a planetary geologist, the author has analyzed results of the various space missions. Based upon this knowledge, he examines the benefits for mankind to be derived from exploration of the solar system. Findings from Venus and Mars have a bearing on Earth's history and geological make-up and climate. Plans to utilize the Moon's minerals and gases are being considered, and the possibility of capturing asteroids as a source of materials has been suggested. The author expresses the hope of peaceful cooperation in space among the major industrialized nations.
Trilateral retinoblastoma: ocular and pineal retinoblastomas
Authors: Johnson Dennis L. , Chandra Roma , Fisher Wink S. , Hammock M. Kathryn , McKeown Craig A.
Published: May 2009

✓ Trilateral retinoblastomas, the syndrome of bilateral retinoblastoma associated with ectopic retinoblastoma in the pineal gland, is rare but well recognized. In contrast to bilateral retinoblastomas alone, the ocular retinoblastomas in trilateral retinoblastoma develop before the age of 6 months, and a family history positive for retinoblastoma is usually obtained. The retinal tumors are often quiescent at the time that the pineal tumor is discovered, and show no evidence of metastatic spread after enucleation of the globes. Pathologically, the pineal tumor is indistinguishable from the ocular retinoblastoma. The pathophysiology of this syndrome is not well understood, but a germinal mutation is thought to target photoreceptor tissue for further postzygotic mutation. Eventual expression depends on the inherited host resistance to the carcinogenic manifestation of these genes. The low host resistance of trilateral retinoblastoma is evident by the early age of presentation, the multicentric occurrence of the tumor, and the high early mortality rate despite aggressive management.
S-100 protein and calmodulin levels in cerebrospinal fluid after subarachnoid hemorrhage
Authors: Takayasu Masakazu , Shibuya Masato , Kanamori Masahiko , Suzuki Yoshio , Ogura Koichiro , Kageyama Naoki , Umekawa Hayato , Hidaka Hiroyoshi
Published: May 2009

✓ The levels of two calcium-binding proteins, S-100 protein and calmodulin, were measured serially in the cerebrospinal fluid (CSF) of patients after subarachnoid hemorrhage (SAH) and aneurysm surgery. These two proteins have a similar molecular structure and are highly concentrated in the central nervous system (CNS). The levels of S-100 protein found in the earliest postoperative CSF samples correlated with the preoperative SAH grades. High S-100 protein levels in the CSF were found in patients with poor SAH grades. Moreover, the prognosis of the patients correlated with the S-100 protein levels in the CSF samples taken during the immediate postoperative period and with the daily changes of the S-100 protein levels. Severe diffuse cerebral vasospasm was followed by a sharp S-100 protein increase. These results suggest that S-100 protein levels in the CSF provide a useful index of organic damage in the CNS, and furthermore that S-100 protein levels and their changes may have prognostic value for patients after SAH. On the other hand, there was a lack of correlation between the calmodulin levels and the preoperative grade or outcome. It would be inappropriate, however, to speculate from the results of this study that these calcium-binding proteins in the CSF play any causative role in pathological processes such as cerebral vasospasm or brain ischemia after SAH, since changes in the levels of these proteins followed the onset of clinical signs of deterioration.
Stem cell studies of human malignant brain tumors
Authors: Pertuiset Bertrand , Dougherty Dolores , Cromeyer Carlos , Hoshino Takao , Berger Mitchel , Rosenblum Mark L.
Published: May 2009

✓ The proliferation kinetics were studied in early-passage cultures of cells from 13 human malignant brain tumors and two specimens of normal brain under conditions similar to those used in clonogenic cell-survival studies. Autoradiography was performed in all but four cases to estimate the fraction of cells actively replicating deoxyribonucleic acid (DNA), the approximate cell cycle time, and the effect of low-dose tritiated thymidine on cell proliferation. The mean tumor cell doubling time (TD) was 53 hours for five glioblastomas, 46 hours for two ependymomas, and 83 hours for two medulloblastomas. A gliosarcoma grew fastest (TD = 22 hours) in culture and a pilocytic astrocytoma grew slowest (TD = 144 hours). The approximate cell cycle time ranged from 1 to 2.5 days for all tumors tested. This suggests that chemotherapeutic agents that predominantly kill proliferating cells should be administered in vitro for at least 2 to 2.5 days to achieve maximum cell kill.

The approximate growth fraction ranged from 0.65 to 0.96 for all tumors except for the two medulloblastomas and the pilocytic astrocytoma, which had growth fractions of 0.34 and 0.35, respectively. Most laboratories investigating the chemosensitivity of primary or early-passage human tumor cells require that 40% to 70% of cells be killed to consider a drug active in vitro. The results of this study suggest that the cell-cycle-specific agents cannot achieve a high enough cell kill to be considered active for some tumors that grow slowly in culture. An estimate of the in vitro growth rate is necessary to reliably interpret cell-survival results with such agents.

Tritiated thymidine appeared to slow cell proliferation in some of the cultures, presumably as a result of radiation-induced DNA damage caused by tritium that had been incorporated into DNA. The degree to which cell growth was slowed in individual tumors correlated with the patient's clinical response to radiation therapy and postoperative survival time.
Beagle puppy model of perinatal cerebral infarction
Authors: Ment Laura R. , Stewart William B. , Duncan Charles C. , Pitt Bruce R. , Rescigno Aldo , Cole Judy
Published: May 2009

✓ Asphyxia, with its attendant hypotension, is by far the most common cause of neonatal cerebral infarction and frequently results in lesions of the parieto-occipital white matter. This study examines the effects of hypotension on regional cerebral blood flow (CBF), local cerebral glucose utilization (LCGU), and serum prostaglandin levels in newborn beagle pups. The animals (24 to 96 hours old) were anesthetized, tracheotomized, and paralyzed. Pups were randomly divided into two groups: one was subjected to hemorrhagic hypotension and the other received no insult. Hypotension was induced by slow venous hemorrhage to maintain a mean arterial blood pressure of 20 to 30 mm Hg. Autoradiographic determinations of LCGU using carbon-14 (14C)-2-deoxyglucose were performed 45 minutes after randomization to groups. Autoradiographic determinations of CBF were performed using 14C-iodoantipyrine on a second group of pups 15 minutes after randomization. Prostaglandins were measured immediately before and 15 minutes after insult or control manipulation. There were no significant differences in the values for thromboxane B2 or 6-keto-prostaglandin F1α, the stable breakdown products of thromboxane A2, and prostacyclin. Prostaglandin E2 levels significantly increased in response to hemorrhagic hypotensive insult. In addition, although regional CBF was maintained in cortical and central gray matter structures during hypotension, CBF to the periventricular temporal and parietal white matter zones significantly decreased, and LCGU was increased in these same regions during hypotensive insult. The uncoupling of CBF and metabolism in these periventricular white matter regions may be responsible for the neuropathological sequelae of perinatal asphyxia.
Spinal intramedullary pseudocyst
Authors: Chuang King-Shun , Wang Yeou-Chih , Tsai Shin-Han , Liu Ming-Ying
Published: May 2009

✓ The authors describe a case of a spinal intramedullary pseudocyst at T-1 that did not communicate with the surrounding spaces. The cystic wall was composed of dense connective tissue without epithelial or neoplastic cells. The patient's condition improved dramatically after surgical removal of the cyst. The literature on spinal intramedullary cystic lesions is reviewed and the etiology of pseudocysts is discussed. This case is believed to be the first in which a pseudocyst has been demonstrated within the spinal cord.
AANS Presidential Address, 1985: The need to trace our roots in difficult times
Authors: Goldring Sidney
Published: May 2009

✓ Several important events that have played a major role in shaping the destiny of neurological surgery are recounted: the birth of neurosurgery; the founding of scientific surgery; the origin and evolution of microvascular technique in cerebrovascular surgery. In each case, the clinical breakthroughs stemmed from an apparently irrelevant basic laboratory investigation. Also, in each case, the transfer of the laboratory results to the bedside required clinicians who were prepared by training and knowledge to recognize the clinical significance of the fundamental observations. History tells us that if we are to sustain neurological surgery as a vibrant surgical specialty, we must continue to give top priority to the preparation of young minds through education and research. It is more important to understand this now than ever before, because never before have we been so preoccupied with social and economic issues: a preoccupation that is threatening to divert our attention from the main determinants of our specialty's future viability — the acquisition and application of new knowledge.
Source of fibrin/fibrinogen degradation products in the CSF after subarachnoid hemorrhage
Authors: Vermeulen Marinus , van Vliet Huub H. D. M. , Lindsay Kenneth W. , Hijdra Albert , Gijn Jan van
Published: May 2009

✓ In 48 patients with a subarachnoid hemorrhage, levels of fibrin/fibrinogen degradation products (FDP's), total protein, and plasminogen were measured in the cerebrospinal fluid (CSF) between Days 9 and 15 after the bleed. Of these 48 patients, 22 received tranexamic acid. Despite a significant reduction in the incidence of rebleeding in patients taking tranexamic acid, no difference in FDP levels was found between patients receiving tranexamic acid and a control group of patients who were not; nor was any relationship evident between FDP levels and rebleeding. In patients with detectable levels of FDP's, CSF protein and plasminogen values were also increased, and FDP's were found more frequently in the CSF of patients with an impaired level of consciousness or with a neurological deficit.

These findings suggest that in the 2nd week after subarachnoid hemorrhage, the presence of FDP's in the CSF reflects a damaged blood-CSF barrier rather than ongoing local fibrinolysis in the subarachnoid space. A finding of FDP's in the CSF is, therefore, an unreliable monitor of antifibrinolytic treatment in subarachnoid hemorrhage and cannot be used for selecting patients at high risk of rebleeding.
Occipital artery to extradural vertebral artery bypass procedure
Authors: Hadley Mark N. , Spetzler Robert F. , Masferrer Roberto , Martin Neil A. , Carter L. Philip
Published: May 2009

✓ A 17-year-old boy suffered blunt trauma to the posterior cervical spine and later developed vertebrobasilar transient ischemic attacks refractory to medical management. At angiography, a pseudoaneurysm of the distal left vertebral artery was found. By means of a posterior midline approach, an extradural occipital artery to vertebral artery anastomosis was performed and the affected vertebral artery was clipped distal to the pseudoaneurysm. The indications for this procedure, the operative approach, and the clinical outcome are described.
Intraventricular hemorrhage in a term neonate secondary to a third ventricular AVM
Authors: Heafner Michael D. , Duncan Charles C. , Kier E. Leon , Ment Laura R. , Scott David T. , Kolaski Raymond , Sorgen Carl
Published: May 2009

✓ An initially healthy infant born of an uncomplicated full-term gestation was brought for evaluation of the acute onset of vomiting, irritability, lethargy, and opisthotonus at 14 days of age. Computerized tomography demonstrated an intraventricular hemorrhage. Arteriography defined an angioma on the roof of the third ventricle which was successfully removed via the transcallosal interfornicial approach on the 34th day of life. Other than an easily controlled seizure disorder, the postoperative course was uneventful. At 8 months of age the child is developing normally. Arteriovenous malformations should be considered in the differential diagnosis of intraventricular hemorrhage in full-term neonates without predisposing trauma or bleeding diathesis. Highspeed digital subtraction arteriography may be used to screen for this diagnosis. The transcallosal interfornicial exposure offers a satisfactory approach for excising third ventricular angiomas in young infants.
Treatment of neoplastic epidural cord compression by vertebral body resection and stabilization
Authors: Sundaresan Narayan , Galicich Joseph H. , Lane Joseph M. , Bains Manjit S. , McCormack Patricia
Published: May 2009

✓ The results of treatment of neoplastic spinal cord compression by vertebral body resection and immediate stabilization in 101 consecutive patients over a 5-year period have been analyzed. Sites of primary cancer included the lung (25 patients), kidney (15 patients), breast (14 patients), connective tissue (12 patients), and a variety of others (35 patients). Of the 101 patients, 23 received surgery de novo; the remaining 78 patients had undergone previous therapy. Sites of involvement included the cervical region in 13 patients, the thoracic region in 68 patients, and the lumbar region in 20 patients. Prior to surgery, severe pain was noted in 90% of the patients, and 45% were non-ambulatory. Using an anterolateral surgical exposure, the vertebral body was resected along with all epidural tumor. Immediate stabilization was achieved with methyl methacrylate and Steinmann pins. Following surgery, the overall ambulation rate was 78%, and 85% of patients experienced pain relief. Of the 23 patients who had received no prior therapy, 90% continued to be ambulatory at their last follow-up examination or until death. The authors believe that surgery prior to irradiation is indicated in selected patients with neoplastic cord compression. In patients with solitary osseous metastasis to the spine, potentially curative resection can be undertaken if surgery is performed when the tumor is still confined to the vertebral body.
Immunobiology of primary intracranial tumors
Authors: Mahaley M. Stephen , Urso Mary B. , Whaley Robert A. , Blue Maxine , Williams Thomas E. , Guaspari Alfred , Selker Robert G.
Published: May 2009

✓ Human lymphoblastoid alpha-interferon was administered intravenously or intramuscularly to 19 patients with recurrent gliomas. Each patient had previously undergone surgery and radiation therapy. The treatment course consisted of 8 weeks of therapy with an escalating daily dosage and number of days of treatment per week to a total dose of 900 × 106 U/sq m. Response to treatment was determined by serial computerized tomography (CT) scans. Seven of the 17 evaluable patients were determined to be treatment responders at 12 weeks (1 month after completion of treatment), and the other 10 patients exhibited tumor progression during this period. Median survival time was 511 days for the responders versus 147 days for the non-responding patients. Interferon appears to be efficacious in the treatment of recurrent anaplastic gliomas as defined by CT brain scan responses following therapy.
CT demonstration of spontaneous internal carotid artery dissection
Authors: Lubbers David J. , Tomsick Thomas A.
Published: May 2009

✓ A case of internal carotid artery dissection is presented. It was diagnosed by computerized tomography (CT) and confirmed by angiography. The typical clinical presentation and radiographic evaluation are briefly reviewed. High-resolution CT scanning with intravenous contrast enhancement is a valuable diagnostic aid in the diagnosis of this entity.
Turcot syndrome (glioma polyposis)
Authors: Chowdhary Upendra Mohan , Boehme Diethelm Hartmut , Al-Jishi Mohammad
Published: May 2009

✓ A case of Turcot syndrome (glioma polyposis) is described in a 22-year-old woman. The patient initially presented with a frontoparietal glioma, and was subsequently found to have segmental colonic polyposis with adenocarcinomatous changes. Her colonic polyposis was nonfamilial.
Acute brain edema in fatal head injury: analysis by dynamic CT scanning
Authors: Yoshino Eiji , Yamaki Tarumi , Higuchi Toshihiro , Horikawa Yoshiharu , Hirakawa Kimiyoshi
Published: May 2009

✓ Dynamic computerized tomography (CT) was performed on 42 patients with acute head injury to evaluate the hemodynamics and to elucidate the nature of fatal diffuse brain bulk enlargement. Patients were divided into two groups according to the outcome: Group A included 17 nonfatally injured patients, eight with acute epidural hematomas and nine with acute subdural hematomas; Group B included 25 fatally injured patients, 16 with acute subdural hematomas and nine with bilateral brain bulk enlargement. Remarkable brain bulk enlargement could be seen in all fatally injured patients with acute subdural hematoma. In 29 (69%) of 42 patients, dynamic CT was performed within 2 hours after the impact.

In the nonfatally injured patients with brain bulk enlargement, dynamic CT scans suggested a hyperemic state. On the other hand, in 17 (68%) of the 25 fatally injured patients, dynamic CT scans revealed a severely ischemic state. In the fatally injured patients with acute subdural hematoma, CT Hounsfield numbers in the enlarged hemisphere (hematoma side) were significantly lower than those of the opposite side (p < 0.001). Severe diffuse brain damage confirmed by follow-up CT scans and uncontrollable high intracranial pressure were noted in the fatally injured patients. Brain bulk enlargement following head injury originates from acute brain edema and an increase of cerebral blood volume. In cases of fatal head injury, acute brain edema is the more common cause of brain bulk enlargement and occurs more rapidly than is usually thought.
Intact arch spondylolisthesis
Authors: Alexander Eben , Kelly David L. , Davis Courtland H. , McWhorter Joe M. , Brown William
Published: May 2009

✓ Over the past 11 years, the authors have treated 50 cases of intact arch spondylolisthesis. There were 38 female and 12 male patients, and all but 11 were older than 60 years of age. Almost all had severe low-back pain made worse by standing or walking. Other common manifestations were unilateral leg pain, numbness or weakness of the leg, and evidence of mild cauda equina compression. Severe cauda equina compression was rare. Myelography invariably showed an extradural dorsal compression. A waist deformity was characteristic in many patients, but 12 had a complete block. In 15 patients (30%) the myelographic impression was that of a herniated intervertebral disc. Most subluxations were of L-4 on L-5. At operation, the facets were found to be thickened, distorted, and irregular. All patients were treated with a wide decompression and laminectomy, which included a medial facetectomy of the inferior and superior facets. An intervertebral disc was removed in 10 patients. Follow-up monitoring of 41 patients (for an average period of 36 months) showed that 26 (63%) were pain-free, 11 had less pain, and four were unimproved. Five other patients with short follow-up periods (average 5 months) were all improved.
The morphology of cerebrospinal fluid drainage pathways in human arachnoid granulations
Authors: Upton Margaret L. , Weller Roy O.
Published: May 2009

✓ Arachnoid granulations and villi from 23 brains from subjects aged 9 to 84 years were examined post mortem by serial sections with the light microscope and as whole or fractured preparations in the scanning electron microscope. The object of the study was to investigate the pathways within the arachnoid granulations by which cerebrospinal fluid (CSF) drains from the subarachnoid space to the sinus endothelium. At the base of each granulation, a thin neck of arachnoid projects through an aperture in the dural lining of the sinus and expands to form a core of collagenous trabeculae and interwoven channels. An apical cap of arachnoid cells, about 150 µm thick, surmounts the collagenous core, and channels extend through the cap to reach subendothelial regions of the granulation. Channels within the granulation are lined by compacted collagen and may contain macrophages. Following recent subarachnoid hemorrhage, erythrocytes are found in the channels, suggesting that the channels are in continuity with the subarachnoid space and are CSF drainage pathways. The cap region of the granulation is only attached to the endothelium over an area 300 µm in diameter; the rest of the granulation core is separated from the endothelium by a subdural space and a fibrous dural cupola. Scanning electron microscopy reveals an intact endothelial surface to the granulations with small perforating venous channels present on the apex of some granulations. The differences between human arachnoid granulations and arachnoid villi in animals are discussed, together with preliminary observations regarding the transition of villi into granulations in man.
Effects of verapamil and diltiazem on acute stroke in cats
Authors: Roy Mark W. , Dempsey Robert J. , Meyer Kathleen L. , Donaldson David L. , Tibbs Phillip A. , Young A. Byron
Published: May 2009

✓ To test the effect of verapamil and diltiazem in acute stroke, three groups of mongrel cats of either sex underwent occlusion of the middle cerebral artery (MCA) via a transorbital approach under ketamine anesthesia. The first group served as controls, the second received an intravenous infusion of verapamil (0.1 µg/kg/min), and the third received an intravenous infusion of diltiazem (0.1 to 1.0 µg/kg/min). All drug infusions began 2 hours before MCA occlusion and continued for the remainder of the experiment. Before and for up to 24 hours after MCA occlusion, regional cerebral blood flow (rCBF), somatosensory evoked potentials (SSEP's), arterial blood gases, blood pressure, temperature, and hematocrit were measured at least every 2 hours. At the experiment's end, brains were perfused with India ink, removed, sliced, photographed for determination of nonperfused brain area, and weighed, dried, and reweighed for H2O content determination. In these studies, verapamil was associated with worsening of rCBF in ischemic regions and inappropriate increases in rCBF in nonischemic regions, indicating intracerebral steal. Diltiazem increased rCBF in marginally ischemic regions. Changes in SSEP's paralleled blood flow changes, with verapamil decreasing amplitude and conduction velocity while diltiazem slightly improved conduction in the ischemic brain. Verapamil increased the area of nonperfused brain and the content of cerebral H2O. Diltiazem-treated animals had decreased cerebral H2O content, but had a marked increase in the area of nonperfused brain, a finding associated with the high incidence of transtentorial herniation in the diltiazem-treated animals. These findings agree with in vitro studies demonstrating high sensitivity of cerebral blood vessels to calcium channel blockers. These studies further support the notion that calcium channel blockers probably affect several different classes of calcium channels, at different brain sites.
Cerebrovascular effects of hypocapnia during adenosine-induced arterial hypotension
Authors: Boarini David J. , Kassell Neal F. , Sprowell James A. , Olin Julie J. , Coester Hans C.
Published: May 2009

✓ Profound arterial hypotension is à commonly used adjunct in surgery for aneurysms and arteriovenous malformations. Hyperventilation with hypocapnia is also used in these patients to increase brain slackness. Both measures reduce cerebral blood flow (CBF). Of concern is whether CBF is reduced below ischemic thresholds when both techniques are employed together. To determine this, 12 mongrel dogs were anesthetized with morphine, nitrous oxide, and oxygen, and then paralyzed with pancuronium and hyperventilated. Arterial pCO2 was controlled by adding CO2 to the inspired gas mixture. Cerebral blood flow was measured at arterial pCO2 levels of 40 and 20 mm Hg both before and after mean arterial pressure was lowered to 40 mm Hg with adenosine enhanced by dipyridamole.

In animals where PaCO2 was reduced to 20 mm Hg and mean arterial pressure was reduced to 40 mm Hg, cardiac index decreased 42% from control and total brain blood flow decreased 45% from control while the cerebral metabolic rate of oxygen was unchanged. Hypocapnia with hypotension resulted in small but statistically significant reductions in all regional blood flows, most notably in the brain stem. The reported effects of hypocapnia on CBF during arterial hypotension vary depending on the hypotensive agents used. Profound hypotension induced with adenosine does not eliminate CO2 reactivity, nor does it lower blood flow to ischemic levels in this model, even in the presence of severe hypocapnia.
Cerebral effects of isovolemic hemodilution with a hypertonic saline solution
Authors: Todd Michael M. , Tommasino Concezione , Moore Suzanne
Published: May 2009

✓ In view of a growing interest in the resuscitative use of hypertonic saline solutions, the authors have examined the cerebral effects of isovolemic hemodilution carried out over 1 hour (hematocrit decreased from 40% to 20%, stable arterial and right arterial pressures), using a hypertonic lactated Ringer's solution (HT-LR:Na+ 252 mEq/liter, osmolality 480 mOsm/liter). Experiments were carried out in anesthetized ventilated rabbits. Measured variables included cerebral blood flow (using the H2 clearance method), intracranial pressure (ICP), the electroencephalogram, spinal cord and skeletal muscle water content (%H2O), and the specific gravity of small (10- to 30-mg) tissue samples taken from different areas of the left hemisphere (including the cortex, thalamus, internal capsule, and hippocampus). The changes produced by HT-LR were compared with those seen in both undiluted control animals and in rabbits hemodiluted with normal saline (Na+ 155 mEq/liter, osmolality 310 mOsm/liter). The results demonstrate that hemodilution with HT-LR leads to the expected increases in serum Na+ and osmolality (158 ± 6 mEq/liter and 320 ± 5 mOsm/kg, respectively, mean ± standard deviation) and that these were accompanied by reductions in the %H2O of all cerebral and extracerebral tissues, increases in the specific gravity of all tissue regions studied, and a decrease in ICP (1.9 ± 0.7 mm Hg). By contrast, rabbits with hemodilution by normal saline showed no changes in either %H2O or specific gravity, but had significant increases in ICP (3.3 ± 1.3 mm Hg). Cerebral blood flow increased in all animals hemodiluted with either HT-LR or normal saline by a combined average of +29 ml/100 gm/min.

Although these studies were performed in neurologically normal animals, the combination of cerebral changes seen with HT-LR (cerebral dehydration, less peripheral edema, decreased ICP but with increased cerebral blood flow) suggests that this approach may have some advantages over the use of isotonic fluids, and may have some utility in the resuscitation of head-injured patients.