bluuebunny/crossref_metadata_2025 huggingface dataset:
Chondroma of the Lumbar Spine, a Rare Cause of Sciatica: Case Report
Authors: Bland Linda I. , McDonald Joseph V.
Published: April 2011

A case of chondroma of the lumbar spine causing nerve root compression is presented. This benign tumor was completely removed, resulting in relief of all radicular symptoms.
Brain Metastasis from Malignant Fibrous Histiocytoma of the Heart: Case Report
Authors: Itoyama Youichi , Nagahiro Shinji , Seto Hiroshi , Sueyoshi Nobuyuki , Kuratsu Jun-ichi , Ushio Yukitaka
Published: April 2011

This is the second reported case of a malignant fibrous histiocytoma of the heart that metastasized to the brain. A 33-year-old woman developed headache, nausea, and ataxic gait 9 months after removal of the tumor from the left atrium of the heart. Computed tomographic and magnetic resonance imaging scans disclosed multiple metastatic tumors in the brain. Although dramatic improvement in her symptoms and signs followed the removal of the brain tumors, she died of tumor recurrence in the left atrium 3 months after the removal of the metastatic brain tumors.
Enlarging Thrombosed Aneurysm of the Distal Basilar Artery
Authors: Batjer Hunt H. , Purdy Phillip D.
Published: April 2011

The case of a 65-year-old man who had partial left third nerve palsy is reported. Radiographic examination disclosed a completely thrombosed giant suprasellar aneurysm. Although an angiogram appeared to indicate that his aneurysm arose from the distal basilar artery, he was also noted to have an unusual and ectatic distal internal carotid artery on the left side, and this was also felt to be a potential source of the aneurysm. Operative exploration was performed and confirmed the basilar artery as the sight of origin, and definitive therapy was deferred. The patient's progress was monitored, and for 3 years his neurological course was stable and there was no change in his radiographic abnormalities. During the 6 months following this period, the patient developed signs and symptoms of progressing hydrocephalus and was found to have significant enlargement of his still completely thrombosed giant aneurysm. This complicated case highlights the controversy regarding the management of this difficult condition, particularly with regard to endovascular therapies, and also provides insight into the evolution of this dynamic disease process.
Giant Aneurysm of the Pericallosal Artery
Authors: Maiuri Francesco , Corriero Giuseppe , D'Amico Luigi , Simonetti Luigi
Published: April 2011

A rare case of a giant aneurysm of the pericallosal artery, evaluated by computed tomography, magnetic resonance imaging, and angiography, is reported, and the other 7 cases in the literature are reviewed, Giant aneurysms are exceptional in the distal segments of the anterior cerebral arteries, and may simulate a callosal tumor or hematoma on computed tomographic scan. The clinical, radiological, surgical, and pathological findings of giant aneurysms of this location are discussed and the other reported cases are analyzed. The role of magnetic resonance imaging in diagnosing and characterizing giant aneurysms is stressed.
Primary Closure of Infected Spinal Wounds
Authors: Dernbach Paul D. , Gomez Heldo , Hahn Joseph
Published: April 2011

Although postoperative infections of spinal wounds are uncommon, when they occur, they cause considerable morbidity. The classic treatment for deep infected wounds of the spine involves opening the wound, packing it, and permitting secondary closure to occur through granulation. A combined total of 10 patients with infected postoperative spinal wounds (two cervical and eight lumbar) from the Lahey Clinic and the Cleveland Clinic were treated by primary closure. Infection was diagnosed, usually within 2 weeks of operation (average, 10.9 days), by increasing back pain, purulent drainage from the incision, cultures, and subfascial extension of the process. In one patient, an associated disk space infection was observed. Causative organisms were Staphylococcus aureus in five patients and Staphylococcus epidermidis in five patients. At the second operation, the wounds were opened and radically debrided, irrigated, and closed primarily over one or two large drains. Treatment with intravenously administered antibiotics was continued postoperatively; the duration of treatment varied from 10 days to 6 weeks, depending on the presence or absence of involvement of bone or disks. Complete resolution of the infections and primary healing of the wounds occurred in all patients. This technique offers advantages over the traditional technique of secondary wound closure by decreasing the amount of wound care and length of hospitalization and is recommended as the treatment of choice for patients with postoperative spinal wound infections.
Radiation Therapy for Arteriovenous Malformations: A Review
Authors: Ogilvy Christopher S.
Published: April 2011

There have been numerous case reports and series of patients treated with partial brain irradiation, linear accelerator-based radiosurgery, gamma knife radiosurgery, and Bragg peak therapy for inoperable arteriovenous malformations (AVMs). These cases are summarized and compared. There is convincing evidence that radiation therapy does have a role in obliterating carefully chosen inoperable lesions. The changes that occur in vessel walls after radiation are reviewed. Data about x-ray and gamma radiation are mostly historical and difficult to evaluate because of the techniques of partial brain irradiation. There is a lack of data about the volume of AVM treated and the minimum dose delivered to the AVM nidus. For gamma knife, heavy particle, and linear accelerator therapy, more complete data are available. The incidence of hemorrhage during the first 2 years after treatment, when radiation-induced vascular changes are proposed to occur, is approximately 2.6% per year for gamma knife therapy, 2% per year for proton beam therapy, 2.3% per year for helium beam therapy, and 2.3% per year for linear accelerator therapy. These rates are similar to the recurrence rate for hemorrhage of 2.2 to 3% per year expected based on the natural history of untreated AVMs. If AVM obliteration after therapy is not achieved, the incidence of recurrent hemorrhage remains between 2% per year after treatment with gamma knife therapy. The incidence of hemorrhage for all patients treated was reported as 0.15% per year in one study and 20% over 8 years in a follow-up study using proton beam therapy. Mortality from hemorrhage after treatment was 0.6% after gamma knife therapy, 2.3% after helium beam therapy, and 2 to 5% after proton beam therapy. These figures for mortality are all lower than the 11% observed for the natural history of untreated AVMs. Permanent neurological deficits experienced as a complication of radiation occurred in 2 to 3% of patients treated with gamma knife therapy, 4% of patients treated with helium beam therapy, 1.7% of patients treated with proton beam therapy, and 3% of patients treated with stereotactic linear accelerator therapy. Proton beam therapy has been used for both small and large lesions. The majority of lesions in patients treated with gamma knife, helium beam, and linear accelerator therapy have been small (usually less than 3.0 cm average diameter) lesions. In these patients with small inoperable lesions treated with accurately directed fields of isocentric radiation, the greatest incidence of AVM obliteration has been observed on follow-up angiograms. Larger lesions may undergo vascular wall thickening with subsequent protection from recurrent hemorrhage, but more data are needed to support this hypothesis.
Cytokine Gene Expression by Human Gliomas
Authors: Lichtor Terry , Dohrmann George J. , Gurney Mark E.
Published: April 2011

Two glioma tumor lines and specimens from five patients with gliomas were analyzed to determine genic expression of four growth factors found in human brain. Messenger RNA encoding for interleukin-1β, interleukin-6, and basic fibroblast growth factor was found to be expressed in significant amounts in some of these tumors, while mRNA for interleukin-3 was found in small quantities in only the tumor lines. Multiple species of mRNA for basic fibroblast growth factor were found. Expression of growth factor genes may play a role in the growth of human gliomas.
Meningioma: A Historical Study of the Tumor and Its Surgical Management
Authors: Al-Rodhan Nayef R. F. , Laws Edward R.
Published: April 2011

The history of meningioma is reviewed, highlighting the personalities and events that shaped our understanding and management of this tumor. Early descriptions, nomenclature, and the history of surgical removal of meningioma are discussed and the important role of this tumor in the development of neurosurgery as a whole is stressed.
Tuberculosis of the Skull—A Rare Condition: Case Report and Review of the Literature
Authors: LeRoux Peter D. , Griffin George E. , Marsh Henry T. , Winn Richard H.
Published: April 2011

A 25-year-old woman exhibited swelling of the scalp and a bony defect of the skull from which Mycobacterium tuberculosis was cultured. The case is reported, and the literature is reviewed.
Lumboperitoneal Shunt: Clinical Applications, Complications, and Comparison with Ventriculoperitoneal Shunt
Authors: Aoki Nobuhiko
Published: April 2011

Lumboperitoneal (LP) shunting has the advantage of completely extracranial surgical management, minimizing intracranial complications. An LP shunt has been intentionally adopted for patients who require cerebrospinal fluid diversion. A retrospective study was designed to examine the indications for and complications associated with LP shunts in 207 patients (including 28 pediatric patients) treated during the past 11 years. Follow-up averaging 5.1 years revealed no deaths related directly to LP shunt placement. Twenty-nine patients (14%) underwent revision of the shunt because of obstruction. Shunt-related infections were observed in only 2 patients (1%). Radicular pain occurred in 10 patients (5%), 2 of whom required shunt replacement. Postoperative occurrence of dyspnea and disturbance of consciousness necessitated conversion to a ventriculoperitoneal (VP) shunt in 2 patients (1%), who subsequently were noted to have Chiari malformations. In 4 patients (2%), an acute subdural hematoma developed after mild head trauma, Symptomatic chronic subdural hematomas were observed in 2 patients (1%). One patient had a mild myelopathy that rapidly resolved after shunt replacement. The comparison to 120 patients treated with a VP shunt during the identical period (an average follow-up of 5.2 years) suggests the following conclusions. After subarachnoid hemorrhage caused by a ruptured aneurysm, hydrocephalus is usually of the communicating type and is an indication for an LP shunt. The incidence of infection and malfunction with an LP shunt is significantly lower than that with a VP shunt. An LP shunt is also indicated for pediatric patients, although a relatively higher incidence of malfunction is noted compared to adults. In the light of their simplicity, extracranial management, and fewer complications, it is suggested that LP shunts be more widely used by neurosurgeons.
The Use of the Potassium Titanyl Phosphate (KTP) Laser in Neurosurgery
Authors: Gamache Francis W. , Patterson Russel H.
Published: April 2011

The potassium titanyl phosphate (KTP) laser recently has been introduced for use in surgery, but as yet, no data have been published concerning the safety or efficacy of use of the KTP laser in neurosurgery. A series of patients treated with the KTP laser that revealed some practical advantages of this instrument over other lasers presently available is reported. The KTP laser has been designed with user safety in mind. In general, the KTP laser, with its angled, lowprofile, lightweight hand pieces, was especially useful in anatomically confined locations, where a laser beam directed from an attachment operated with a joy stick mounted on the operating microscope would prove awkward. The KTP laser provided very good hemostasis. Certain large fibrous tumors were found to be more easily removed using a combination of the KTP laser and ultrasonic aspiration rather than with either instrument alone.
Aneurysms of the Posterior Inferior Cerebellar Artery-Vertebral Artery Complex: Variations on a Theme
Authors: Salcman Michael , Rigamonti Daniele , Numaguchi Yuji , Sadato Norihiro
Published: April 2011

Aneurysms of the posterior inferior cerebellar artery-vertebral artery complex are relatively uncommon lesions. They include aneurysms at the origin of the posterior inferior cerebellar artery (PICA-VA), aneurysms on the distal artery (PICA) and aneurysms at the junction of the vertebral and basilar arteries (VA-BA). We have had the opportunity to treat 17 patients and study the radiological records of 9 additional patients in the past 8 years. The aneurysms ranged in size from 3 to 30 mm, with mean values of 10.6, 7.3, and 9 mm for PICA-VA lesions, distal PICA lesions, and VA-BA lesions, respectively. Three of the 4 VA-BA aneurysms were located at the midline, and the mean distance of the PICA-VA aneurysms from the midline was 7.6 to 9.4 mm; 2 aneurysms crossed the midline from their parent VA. The aneurysms were located slightly more often on the left side (left:right ratio, 1:2), were found more frequently in women (2.25:1), and occurred at a mean age of 50 years. Ten aneurysms at the origin of the PICA and 4 VA-BA aneurysms were treated via a lateral suboccipital craniectomy; 3 distal PICA aneurysms were exposed by a midline craniectomy. Surgery was carried out acutely in 5 patients. Tortuousness of the VA required contralateral approaches in 2 patients, an exploratory craniectomy in 1 patient, and an approach toward the dome of 1 patient with a VA-BA aneurysm. Morbidity was primarily due to cranial nerve dysfunction. There were no perioperative deaths. These aneurysms can easily be missed on initial radiographic examination; one appeared only on the second study, one was seen to grow over 16 days, and one was discovered at the level of C1 extracranially. Our radiographic and surgical approach to the treatment of these lesions is presented.
The Identification of Adrenergic Receptors in Human Pial Membranes
Authors: Alexander Eben , Friedman Allan H.
Published: April 2011

Recent experimental work has suggested that the adrenergic nervous system is important in regulating cerebral blood flow under conditions of hypoxia and systemic arterial hypertension. Although previous investigations have demonstrated the presence of adrenergic neurons adjacent to human cerebral vessels, the nature of adrenergic receptors on human cerebral blood vessels remains poorly defined. The present study was performed to characterize adrenergic reception on membranes prepared from human pia, a rich source of small blood vessels, using radioligand binding techniques. Adrenergic membrane receptors were characterized using the binding of [3H]dihydroalprenolol for the B subtypes and [3H]prazosin and [3H]yohimbine for the A subtypes. Displaceable binding was demonstrated with each agent. A small series of adrenergic agents competed for the [3H]dihydroalprenolol, [3H]yohimbine, and [3H]praz binding sites in a fashion suggesting the presence of A1-, A2-, B1and B2-receptors on the vessels within human pia.
Congenital Fistula of the Dural Carotid-Cavernous Sinus: Case Report and Review of the Literature
Authors: Konishi Yoshifumi , Hieshima Grant B. , Hara Mitsuhiro , Yoshino Kei , Yano Keiko , Takeuchi Kazuo
Published: April 2011

The case of a 2-month-old boy with a congenital fistula of the dural carotid-cavernous sinus is presented. This is a rare vascular anomaly in infancy, and it may cause acute changes in vision. The child was initially followed up for 1 year to see if spontaneous thrombosis would occur. The symptoms persisted, however, and intravascular surgery using platinum coils was performed for closure. After treatment, the symptoms completely resolved. Literature pertaining to this anomaly has been reviewed with particular emphasis on dural fistulas of the cavernous, transverse, sigmoid, and straight sinuses in infancy.
Primary Intracerebral Plasma Cell Granuloma: A Light, Immunocytochemical, and Ultrastructural Study of One Case
Authors: Figarella-Branger D. , Gambarelli D. , Perez-Castillo M. , Garbe L. , Grisoli F.
Published: April 2011

A case of primary intracerebral plasma cell granuloma without meningeal attachment is presented. Histologically, the lesion showed two different patterns. At the center, it displayed the features of a benign fibrous histiocytoma. At the periphery, a mixture of polyclonal plasma cells, lymphocytes, and “epithelial-like”cells was observed. Electron microscopy and immunocytochemistry confirmed the histiocytic nature of the “epithelial-like cells.” The differential diagnosis and histogenesis of such a lesion are discussed.
Cavernous Angioma of the Cavernous Sinus: Case Report
Authors: Sepehrnia Abolghassem , Tatagiba Marcos , Brandis Almuth , Samii Madjid , Prawitz Ralph-Hubertus
Published: April 2011

An unusual case of cavernous angioma in the cavernous sinus (“cavernous cavernoma”) is presented. The acute onset of symptoms simulated Tolosa-Hunt syndrome, and after neuroradiological investigations, the suspected diagnosis was an intracavernous meningioma. Macroscopical intraoperative and histopathological findings demonstrated a cavernous angioma. The lesion was completely removed from the cavernous sinus without additional neurological deficits and with improvement of the symptoms. Three additional cases in the literature are reviewed. The rarity of these lesions and the management problems related to their location in the cavernous sinus are stressed.
Spinal Epidural Abscess: A Ten-Year Perspective
Authors: Hlavin Mary Louise , Kaminski Henry J. , Ross Jeffery S. , Ganz Edward
Published: April 2011

A retrospective study of spinal epidural abscess spanning 10 years and encompassing 40 patients was done. Epidemiology, clinical features, laboratory findings, radiographic imaging, therapy, and outcome were examined and compared with previous series. An increasing incidence of the disease (up to 1.96 patients per 10,000 admissions per year) and an older, more debilitated population (67% having factors predisposing them to infection) were discovered. Over half of the population was studied with magnetic resonance imaging, which was found to be equally as sensitive (91%) as myelography with computed tomography (92%). Magnetic resonance imaging offers the advantages of being noninvasive and able to delineate other entities, which makes it the imaging modality of choice. Preoperative paralysis and neurological deterioration from normal were identified as poor prognostic features. Of 7 patients with preoperative paralysis, 5 died, and the rest failed to recover neurological function. Eleven patients with initially normal neurological exams deteriorated in the hospital before surgical intervention. Eight of these patients were being treated with appropriate antibiotics; 2 became paralyzed despite more than 3 weeks of antibiotic therapy. Only 3 of these 11 patients recovered fully. Immediate surgical decompression combined with antibiotics remains the treatment of choice.
Localization and Characterization of Endothelin Receptors in Human Gliomas: A Growth Factor?
Authors: Kurihara Masaki , Ochi Akira , Kawaguchi Tsutomu , Niwa Masami , Kataoka Yasufumi , Mori Kazuo
Published: April 2011

Localization and characterization of endothelin receptors in surgical specimens of human gliomas (6 benign astrocytomas and 7 glioblastomas multiforme) and in normal human cortices were studied using quantitative receptor autoradiographic methods. Low numbers of [125 I]endothelin-1 ([125I] ET-1) binding sites were detected in the gray matter of the human frontal cortex, with little binding in the white matter. Conversely, relatively high numbers of [125I]ET-1 binding sites were homogeneously present in tissue sections derived from astrocytomas, whereas higher numbers of [125I]ET-1 binding sites were heterogeneously located on groups of cells with a pseudopalisading appearance and pleomorphic astrocytes in glioblastoma multiforme. Necrotic areas within the tissue sections derived from glioblastoma were devoid of binding. Binding of [125I]ET-1 to gliomas and normal gray matter was specific. Unlabeled ET-1 and its natural analogs (ET-2 and ET-3) inhibited the binding of [125I]ET-1 to these lesions in a concentration-dependent manner and with similar high potencies. Possibly related substances, such as ion channel regulators (w-conotoxin. apamin. and tetrodotoxin). a Ca2+channel blocker (nicardipine). and growth factors (epidermal growth factor and insulin-like growth factor I). did not affect the binding to tissue sections derived from gliomas or from normal frontal cortices. Scatchard analysis revealed the presence of a single class and high-affinity binding sites for endothelin in normal cortex and in gliomas. There was no significant difference in the binding affinities: dissociation constants (Kd) were 2.1 ± 0.5 nM in 6 astrocytomas, 2.5 ± 0.4 nM in 7 glioblastomas. and 1.4 and 1.5 nM in two normal cortices. The concentrations of [125I]ET-1 binding sites were significantly higher in glioblastomas than in astrocytomas: the maximum number of binding sites (Bmax) was 30 ± 6 fmol/mg in 6 astrocytomas and 60 ± 11 fmol/mg in 7 glioblastomas (P < 0.05. F= 5.61), and 14 and 16 fmol/mg in two normal cortices. These observations suggest the presence of a specific receptor for endothelin in human gliomas. Endothelin may be involved in the modulation of growth in gliomas.
Entrapment of the C2 Root and Ganglion by the Atlanto-Epistrophic Ligament: Clinical Syndrome and Surgical Anatomy
Authors: Poletti Charles E. , Sweet William H.
Published: April 2011

Two cases of progressive, occipital lancinating pain and dysesthesias associated with a sensory deficit of the C2 dermatome are presented. Symptoms were relieved, and C2 sensory function restored by releasing a hypertrophied atlanto-epistrophic ligament entrapping the C2 root and ganglion. The normal anatomy and abnormal surgical findings are described. C2 entrapment by the atlanto-epistrophic ligament is discussed in reference to other C2 lesions causing occipital pain. We conclude that some patients whose progressive occipital pain is accompanied by a C2 sensory deficit are suffering from entrapment of the C2 root and ganglion amenable to surgical decompression.
Clinical Study of Intracranial Nongerminomatous Germ Cell Tumors Producing Α-Fetoprotein
Authors: Itoyama Youichi , Kochi Masato , Yamamoto Haruaki , Kuratsu Jun-ichi , Uemura Shozaburou , Ushio Yukitaka
Published: April 2011

We present six patients with intracranial nongerminomatous germ cell tumors that produced Α-fetoprotein (AFP). Their ages ranged from 8 to 20 years (average, 11.5 years old); two were male and four were female. Four of the tumors originated in the pineal region and two in the suprachiasmatic region. One patient treated with only radiation therapy died within 3 months of admission as a result of intraperitoneal metastasis via a ventriculoperitoneal shunt. Another patient, treated with radiation therapy and intrathecal administration of neocarzinostatin, died after 12 months because of tumor progression and subarachnoid dissemination. Two patients who received radiation and combination therapy with cisplatin, vinblastine, and bleomycin died after 13 and 25 months. The remaining two patients treated with radiation therapy and adjuvant chemotherapy (cisplatin and etoposide) are now alive without recurrence after 16 and 19 months from admission. Adjuvant chemotherapy with cisplatin and etoposide appears to be efficacious in the treatment of intracranial nongerminomatous germ cell tumor.
Occult Vascular Malformations of the Optic Chiasm: Magnetic Resonance Imaging Diagnosis and Surgical Laser Resection
Authors: Steinberg Gary K. , Marks Michael P. , Shuer Lawrence M. , Sogg Richard L. , Enzmann Dieter R. , Silverberg Gerald D.
Published: April 2011

Angiographically occult vascular malformations of the optic nerve and chiasm are extremely rare. Before the advent of magnetic resonance imaging (MRI), it was difficult to diagnose these lesions preoperatively. We report MRI scan findings of optic chiasm cavernous angiomas in two patients with chiasmal syndrome. MRI was useful in localizing the vascular malformation and delineating its characteristics, especially chronic hemorrhage. One patient underwent biopsy of the lesion. The other patient underwent complete microsurgical resection of the malformation with the carbon dioxide laser with preservation of vision. Occult vascular malformations of the optic nerve and chiasm may be a more common cause of visual deterioration than previously recognized. The MRI scan is the imaging modality of choice for diagnosing and following these lesions. In certain patients, these vascular malformations may be amenable to complete surgical removal with stabilization or improvement of visual function.
Brain Stem and Spinal Metastases of Supratentorial Glioblastoma Multiforme: A Clinical Series
Authors: Vertosick Frank T. , Selker Robert G.
Published: April 2011

Although the spread of supratentorial glioblastoma multiforme to the brain stem and spine has been extensively described in published autopsy series, information on the diagnosis, treatment, and subsequent clinical course of patients manifesting symptoms of glioblastomatous dissemination ante mortem remains scant. We report a series of 11 patients having the signs and symptoms of neuraxis dissemination of supratentorial glioblastoma multiforme. All patients had radiographic documentation of metastases by either contrast-enhanced myelograms or enhanced magnetic resonance imaging scans. Ten presented with spinal involvement, whereas one presented with lower cranial neuropathies secondary to diffuse involvement of the basal cisterns. The mean age of the patients was 38.5 years, and the mean time interval between diagnosis of intracranial disease and diagnosis of metastases was 14.1 months. After diagnosis of tumor spread, subsequent mean survival time was 2.8 months. All patients received additional radiotherapy to the areas of metastasis, but the clinical response to radiotherapy was quite poor. This study confirms previous reports in the literature suggesting that metastases occur in younger patients and in patients with extended survival. The findings suggest that the relatively infrequent clinical incidence of the symptomatic spread of glioblastoma multiforme, as compared with the frequent incidental discovery of such spread at autopsy, may be the result of the limited survival of the affected patients, and not due to the biology of the tumor.
Changes in Intracochlear and Intracanalicular Nerves after Acoustic Neurinoma Excision Confirmed by Magnetic Resonance Imaging
Authors: Sekiya Tetsuji , Suzuki Shigeharu , Iwabuchi Takashi
Published: April 2011

Postoperative magnetic resonance imaging findings related to the vestibulocochlear and facial nerves within the internal auditory canal were analyzed in acoustic neurinomas. T1-and proton-weighted magnetic resonance images showed that the vestibulocochlear nerves distal to the internal auditory meatus increased in signal intensity after surgical intervention. These nerves were conspicuously enhanced after intravenous administration of gadolinium diethylene-triamine-pentaacetic acid. The preserved facial nerves were also markedly enhanced postoperatively. As a possible cause of these findings, we suggest operative disruption of the blood-nerve barrier with ensuing nerve edema, although the operative procedures were carefully carried out using a surgical microscope. The clinical significance of traumatic disruption of the blood-nerve barrier and subsequent nerve edema are discussed from the standpoint of preservation of cochlear nerve function.
Radiation Necrosis of the Optic Chiasm, Optic Tract, Hypothalamus, and Upper Pons after Radiotherapy for Pituitary Adenoma, Detected by Gadolinium-Enhanced, T1-Weighted Magnetic Resonance Imaging: Case Report
Authors: Tachibana Osamu , Yamaguchi Narihito , Yamashima Tetsumori , Yamashita Junkoh
Published: April 2011

A 26-year-old woman was treated for a prolactin secreting pituitary adenoma by surgery and radiotherapy (5860 rads). Fourteen months later, she developed right hemiparesis and dysarthria. A T1-weighted magnetic resonance imaging scan using gadolinium contrast showed a small, enhanced lesion in the upper pons. Seven months later, she had a sudden onset of loss of vision, and radiation optic neuropathy was diagnosed. A T1-weighted magnetic resonance imaging scan showed widespread gadolinium-enhanced lesions in the optic chiasm, optic tract, and hypothalamus. Magnetic resonance imaging is indispensable for the early diagnosis of radiation necrosis, which is not visualized by radiography or computed tomography.
Hemorrhagic Pituitary Adenomas: Clinicopathological Features and Surgical Treatment
Authors: Fraioli Bernardo , Esposito Vincenzo , Palma Lucio , Cantore Giampaolo
Published: April 2011

Forty-five (9.9%) of 453 pituitary adenomas operated on between January 1973 and November 1988 demonstrated hemorrhagic changes at surgery: 24 had a blood collection, 12 had a blood collection associated with hemorrhagic necrosis, and 9 had hemorrhagic necrosis. Thirteen patients (28.9%) experienced the acute symptoms of pituitary apoplexy, whereas another 32 had an “asymptomatic” hemorrhage, that is. the clinical course was comparable to an uncomplicated adenoma. Nineteen tumors (42.2%) showed marked suprasellar extension, 8 (17.8%) showed moderate extension, and 11 (24.5%) showed slight extension; another 2 (4.4%) were laterosellar and 5 (11.1%) were intrasellar. Invasive behavior was present in 32 cases (71.1%) and this may suggest another hypothesis to explain the pathogenesis of tumoral hemorrhage. The incidence of hemorrhagic complications in invasive adenomas with marked suprasellar extension was particularly impressive; therefore, we do not suggest preoperative bromocriptine treatment in this type of tumor. Two of 14 patients operated on by the transcranial route died after surgery. whereas there was no operative mortality in the 31 patients operated on by the transsphenoidal route. It proved advantageous to operate as early as possible, even during the acute phase of pituitary apoplexy. The transsphenoidal approach gave the best results, but to achieve satisfactory late results multidisciplinary treatment was necessary, namely, postoperative radiotherapy in 23 patients, bromocriptine in 12. and endocrine replacement therapy in almost all. In an average follow-up period of 6.2 years. 5 (11.1%) symptomatic recurrences were observed.
Antimigraine Treatment for Slit Ventricle Syndrome
Authors: Obana William G. , Raskin Neil H. , Cogen Philip H. , Szymanski Joyce A. , Edwards Michael S.B.
Published: April 2011

Slit ventricle syndrome is characterized by chronic or recurring headaches associated with subnormal ventricular volume in patients who have undergone shunt treatment for hydrocephalus. There appear to be at least three pathophysiological mechanisms that cause this syndrome: 1) intermittent shunt malfunction: 2) intracranial hypotension: and 3) paroxysms of increased intracranial pressure in the presence of normal shunt function. To treat seven patients with slit ventricle syndrome caused by paroxysms of elevated intracranial pressure, we successfully used antimigraine therapy rather than standard calvarial expansion procedures. None of these patients has required shunt revision or calvarial expansion during a mean follow-up period of 2 years. The symptoms of slit ventricle syndrome may be a form of “acquired” migraine in shunt patients. We suggest that, in clinically stable patients with normal shunt function, treatment against migraine may stabilize symptoms resulting from paroxysms of increased intracranial pressure. Such treatment may prevent unnecessary shunt revisions and/or calvarial expansion procedures.
Persistent Primitive Trigeminal Artery-Cavernous Sinus Fistulas: Report of Two Cases
Authors: Guglielmi Guido , Viñuela Fernando , Dion Jacques , Duckwiler Gary , Cantore Giampaolo , Delfini Roberto
Published: April 2011

Two cases of persistent Primitive trigeminal artery-cavernous sinus fistulas are presented. In one case, the fistula was treated by using a two-balloon tandem technique. This method was accomplished by introducing, inflating, and detaching a silicone balloon into the trigeminal artery, thus preserving the carotid and basilar blood flow. An unusual case of a similar fistula with only contralateral exophthalmos is also reported. The relationship between this type of fistula and the presence of aneurysms on the persistent primitive trigeminal artery and the relationship with traumatic events are discussed.
A Detachable Balloon Procedure for a Traumatic Internal Carotid-Internal Jugular Fistula: Report of a Case
Authors: Niijima Kyo Huang , Yonekawa Yasuhiro , Taki Waro
Published: April 2011

A case of a traumatic fistula between the internal carotid artery and the internal jugular vein is reported. The fistula was treated by detachable balloon occlusion and clipping of the internal carotid artery.
Syringomyelia Secondary to Compression of the Cervical Spinal Cord by an Extramedullary Lymphoma
Authors: Hormigo Adilia , Lobo-Antunes J. , Bravo-Marques J. M. , Marques Silvério M.
Published: April 2011

A case of syringomyelia secondary to an extramedullary cervical spinal cord compression by a non-Hodgkin's lymphoma is described. After radiotherapy. the syrinx was no longer seen. The pathogenesis of this type of syrinx is discussed, and the potential benefit of radiotherapy in these cases is suggested.
Biomechanics of Lumbar Pedicle Screw/Plate Fixation in Trauma
Authors: Yoganandan Narayan , Larson Sanford J. , Pintar Frank , Maiman Dennis J. , Reinartz John , Sances Anthony
Published: April 2011

This investigation was conducted to determine alterations in the biomechanical strength and stiffness characteristics of the lumbar spine fixated with Steffee instrumentation. Comparative studies of these parameters were conducted using seven lumbar columns from fresh human cadavers. Three runs were conducted on each T12-L5 column: control, injured, and fixated. The specimens were loaded under the compression-flexion mode until failure (control run) and then reloaded (injury run) to the failure deformation determined in the control run. Screw/plates were then inserted one level proximal and distal to injury, and the specimens were reloaded (fixation run). Radiographs were taken before and after each trial. Data on deformation and force histories were gathered. The load-deflection response of the injured and fixated specimens were bimodal with two representative stiffnesses. Control failure loads and stiffnesses were higher than those for the injured (P < 0.001) or fixated (P < 0.01) spine. Initial stiffness was significantly higher for the fixated than for injured columns (P < 0.001), but the final stiffnesses were similar. The increase in the initial stiffness in the fixated specimen compared to the injured specimen indicates the strength added to the posterior region of the spine. The relatively smaller alteration in the final stiffness between the fixated and the injured columns, corresponding to the load shared by the anterior column, may suggest that, above a critical strain level, the anterior column absorbs a higher portion of the external load and posterior fixation may be inadequate as sole treatment in trauma.
Myeloma Manifesting as a Large Jugular Tumor: Case Report
Authors: Miyachi Shigeru , Negoro Makoto , Saito Kiyoshi , Nehashi Kyoko , Sugita Kenichiro
Published: April 2011

The authors report a case of cranial plasmacytoma with multiple myelomas and palsy of the lower cranial nerves. The osteolytic lesion adjacent to the jugular foramen was demonstrated by an angiogram to be exceedingly hypervascular, with arteriovenous shunting resembling that seen in paragangliomas. Forty-five cases of cranial and intracranial plasmacytoma from the literature were reviewed. The findings indicate that a cranial plasmacytoma commonly appears to be a hypervascular tumor, whereas most dural tumors or intraparenchymal tumors have poor vascularity.
Giant Intradiploic Epidermoid Tumor of the Occipital Bone: Case Report
Authors: Guridi Jorge , Ollier Jorge , Aguilera Francisco
Published: April 2011

The authors describe a case of a giant intradiploic epidermoid cyst of the occipital bone with an intracranial extension in the posterior fossa and no signs of neurological involvement. The lesion started as a painless lump under the scalp. Roentgenographic and computed tomographic findings led to a correct diagnosis, and the complete removal of the cyst was accomplished, despite its large size. The total removal of these cysts is associated with a good prognosis.
Magnetic Resonance Imaging in the Preoperative Evaluation of Cervical Radiculopathy
Authors: Wilson Donald W. , Pezzuti Roger T. , Place James N.
Published: April 2011

Forty patients with cervical radiculopathy were examined preoperatively with magnetic resonance imaging (MRI). MRI was used alone in 27 (68%) of the 40 patients; the remainder also had computed tomography in conjunction with myelography. The primary criterion on MRI for a clinically significant lesion was asymmetrical narrowing of the subarachnoid space in the region of the nerve root. Surgical confirmation of the abnormality was obtained in all 40 cases. The operative findings were a herniated nucleus pulposus (32 of 40 patients), spondylosis (2 of 40 patients), or a combination of the two (6 of 40 patients). MRI identified a surgical lesion (herniated nucleus pulposus, spondylosis, or both) in 37 of the 40 (92%) patients. We think MRI is the only preoperative imaging examination necessary in most cases of cervical radiculopathy.
Spinal Glioblastomas: Report of Seven Cases and Review of the Literature
Authors: Ciappetta Pasquale , Salvati Maurizio , Capoccia Giovanna , Artico Marco , Raco Antonino , Fortuna Aldo
Published: April 2011

Intramedullary glioblastomas are uncommon tumors. They occur chiefly in the cervicothoracic segments, have a slight tendency to occur in the early decades of life, and have a short clinical history before diagnosis. We report seven cases and discuss the salient features of these tumors, particularly the pathological features and treatment, in light of the relevant literature.
Current Treatment of Chiari Malformations Types I and II: A Survey of the Pediatric Section of the American Association of Neurological Surgeons
Authors: Haines Stephen J. , Berger Mitchel
Published: April 2011

The membership of the Pediatric Section of the American Association of Neurological Surgeons was surveyed with regard to attitudes in current practice in the treatment of Chiari malformations Types I and II. Ninety-six of 152 (63%) valid questionnaires were returned. The median number of malformations treated yearly by the respondents was 3 for Type I and 6 for Type II. There was substantial agreement that surgery should not be carried out on asymptomatic patients and that surgery was indicated for the treatment of brain stem dysfunction, cranial nerve dysfunction, hydromyelia, and scoliosis associated with these malformations. There was substantial disagreement about lesser indications for surgery. The respondents also expressed dissatisfaction with the current classification of Chiari malformations. Chiari malformations are complex abnormalities, and their anatomy is being better delineated with magnetic resonance imaging. Carefully designed scientific clinical investigations are needed to improve our understanding and treatment of Chiari malformations.
Surgical Treatment of a Rare Congenital Anomaly of the Vertebral Artery: Case Report and Review of the Literature
Authors: Vincentelli François , Caruso Giuseppe , Rabehanta Pierre B. , Rey Marc
Published: April 2011

A case of an abnormal loop of the vertebral artery compressing both the cervicomedullary junction and the accessory nerve is reported. The embryological development of the vertebrobasilar system may explain this anatomical anomaly. The possibility of an abnormal location of the vertebral artery may complicate the lateral C1-C2 puncture for myelography. Only five similar cases have been reported previously, but none of them presented any clinical symptomatology, and surgical treatment was never required. The present patient was cured by microvascular decompression. The pathogenetic and surgical implications are discussed in light of the literature.
Barbed Spear Injury to the Skull Base: Case Report
Authors: Mezue Wilfred Chukwuemeka , Saddeqi Norrudeen , Ude Anthony
Published: April 2011

A case of a barbed spear injury to the left orbit and skull base is presented. The unusual nature and circumstances of the injury and the management problems related to the proximate neurovascular bundles are discussed.
Syringomyelia as a Postoperative Sequela of the Resection of a Chordoma of the Clivus: Case Report
Authors: Lovely Thomas J. , Buchheit William A.
Published: April 2011

Syringomyelia has been described frequently in association with various abnormalities of the skull base but rarely with tumors of the skull base. Syringomyelia as a postoperative sequela of surgery of the skull base has not been reported. The authors describe a case of cervical syringomyelia developing after the partial resection of a chordoma and combined conventional and proton beam irradiation. The possible mechanisms causing this abnormality are discussed.
Tuberothalamic Infarct after Division of a Hypoplastic Posterior Communicating Artery for Clipping of a Basilar Tip Aneurysm: Case Report
Authors: Regli Luca , de Tribolet Nicolas
Published: April 2011

The authors present a case of a tuberothalamic infarct subsequent to division of the posterior communicating artery for clipping of a high-lying aneurysm of the basilar bifurcation using the pterional approach. In view of this clinical observation and some particular aspects of the microsurgical anatomy of the perforating vessels of the posterior communicating artery, we conclude that interrupting this parent vessel carries a significant risk of infarction.
Continuous Regional Cerebral Blood Flow Monitoring in Acute Craniocerebral Trauma
Authors: Dickman Curtis A. , Carter L. Philip , Baldwin Hillel Z. , Harrington Timothy , Tallman David
Published: April 2011

Regional cortical cerebral blood flow (rCBF) and intracranial pressure (ICP) were monitored continuously with a combined thermal diffusion probe/ICP monitor in 12 patients (8 men and 4 women; mean age, 31 years; range, 7-65 years) with acute head injuries. The mean Glasgow Coma Scale score at admission was 6 (range, 4-12). The rCBF/ICP probes were placed during surgical procedures (n = 11) or in an intensive care unit (n = 1) for subdural hematomas (n = 7), cerebral contusions (n = 4), and an epidural hematoma (n = 1). No probe-related complications occurred. Reduced CBF often occurred and was often inversely proportional to elevations in ICP. Posttraumatic cerebral arterial vasospasm in one patient was detected by rCBF monitoring and confirmed by angiography. In 6 patients who progressed to brain death, rCBF patterns disappeared, which correlated with their clinical and electroencephalographic examinations. Several patients with severe, diffuse brain injuries and high ICP had hyperemic rCBF patterns. In 2 of these patients, increases in rCBF preceded rises in ICP, which implied loss of autoregulation as a mechanism in the development of malignant cerebral edema. This method of CBF monitoring has not yet been established for clinical decision making. The early detection of ischemic or hyperemic responses by continuous CBF monitoring could hasten intervention aimed at restoring adequate tissue perfusion. The technique could also serve as an index of the efficacy of therapeutic interventions and is suitable to gain more insight into the pathophysiology of head injury, especially the relationship of CBF to ICP.
Prolactin Reduction after Combined Therapy for Prolactin Macroadenomas
Authors: Rush Stephen , Donahue Bernardine , Cooper Paul , Lee Christopher , Persky Mark , Newall Joseph
Published: April 2011

The ability of surgery or bromocriptine to produce endocrine control of a prolactin macroadenoma decreases as the prolactin level increases. Guidelines for the use of multimodality therapy have not been developed for tumors associated with markedly elevated prolactin levels. We reviewed the records of 21 patients with prolactin levels >200 ng/ml treated by transsphenoidal surgery and postoperative radiotherapy with or without a dopamine agonist. Values before and after treatment were available for 19 patients (13 men and 6 women);. The mean basal prolactin level before treatment for the entire group was 2410 ng/ml. Surgery and radiotherapy resulted in a 90% reduction and serum prolactin levels within normal limits in 0 of 7 patients, versus the combination of surgery, radiotherapy, and dopamine agonist, which resulted in a 99.5% reduction and values within the normal range in 12 of 12 patients. Spontaneous physiological improvement was not often observed. One woman and two men were able subsequently to have children. A plan for these patients is discussed.
Syndrome of the Cervical Plexus Caused by High Cervical Nerve Root Compression
Authors: Kessler Laibe A. , Abla Adnan
Published: April 2011

Lesions affecting the roots of the cervical plexus can cause a syndrome not previously described. The C3-C4 disc space is the most likely to be involved, but pressure on the C5 root can also produce facial, auricular, or retroauricular pain. Motor innervation to the diaphragm can be affected, and even the uppermost disc space at C2-C3 might be implicated. Findings on examination findings are sparse, although sensory impairment in areas of cervical plexus innervation has been observed. In a series of 1000 cervical decompression cases (both anterior and posterior); for disc disease or similar processes, only 10 instances of this syndrome have been found. Paresthesia or episodic shock-like pain affecting the ear, para-auricular, lower occipital, and mandibular areas prompted by head turning or extension are the most common complaints.
Intracerebral Hemorrhage after Lumbar Myelography with Iohexol: Report of a Case and Review of the Literature
Authors: Van de Kelft Erik , Bosmans Jan , Parizel Paul M. , Van Vyve Michel , Selosse Paul
Published: April 2011

Intracranial hemorrhage is an uncommon complication of dural puncture. In most instances, hematomas are subdural: they may be unilateral or bilateral. Rarely are intraparenchymal cerebral hemorrhages related to dural puncture. This report describes a delayed occurrence of bilateral intraparenchymal hemorrhages in a 38-year-old woman 7 days after lumbar myelography with iohexol. A review of the literature is presented.
Stabilization of the Cervical Spine in Spondyloepiphyseal Dysplasia Congenita
Authors: LeDoux Mark S. , Naftalis Richard C. , Aronin Patricia A.
Published: April 2011

Spondyloepiphyseal dysplasia congenita is an inheritable bone dysplasia causing abnormalities that manifest at birth and primarily involve the spine and proximal epiphyses. The clinical findings include short-trunk dwarfism, myopia, frequent retinal detachment, shortening of the spine and proximal extremities, mild thoracic kyphoscoliosis, a barrel-shaped thorax, a short neck, and mild ocular hypertelorism. The characteristic radiographic features are a generalized delay in ossification, flattening and dysplasia of the vertebral bodies, pelvic dysplasia, and retarded ossification of the femoral head and neck. Other radiographic features of interest to the neurosurgeon may be platybasia, kyphoscoliosis, lumbar hyperlordosis, and odontoid hypoplasia. A case of spondyloepiphyseal dysplasia congenita is presented in which an unstable and markedly dysplastic cervical spine was stabilized with Halifax interlaminar clamps and sublaminar wires. The clinical findings and radiographic features are presented and the etiology and neurosurgical management of spondyloepiphyseal dysplasia congenita are discussed.