bluuebunny/crossref_metadata_2025 huggingface dataset:
Platelet-activating factor (PAF) concentration and PAF acetylhydrolase activity in cerebrospinal fluid of patients with subarachnoid hemorrhage
Authors: Hirashima Yutaka , Endo Shunro , Ohmori Tomoaki , Kato Ryoko , Takaku Akira
Published: May 2009

✓ The authors studied the sequential changes in platelet-activating factor (PAF) and PAF acetylhydrolase in the cerebrospinal fluid (CSF) of patients with subarachnoid hemorrhage (SAH). Levels of PAF in CSF showed a gradual increase after the onset of SAH, with a subsequent decrease. The PAF concentration between 5 and 9 days after SAH was greater in patients with cerebral infarction due to vasospasm than in patients without infarction. Conversely, PAF acetylhydrolase activity decreased gradually after SAH, then increased. The enzyme activity for the same period was smaller in patients with cerebral infarction than in patients without infarction. The distribution of the days of maximum PAF concentration and minimum PAF acetylhydrolase activity did not differ significantly between the two groups. The CSF as a source of PAF acetylhydrolase activity gave an apparent Michaelis constant value of 90.8 µM and a maximum velocity of 0.2 nmol/min/mg. The optimum pH level for the PAF acetylhydrolase activity obtained from CSF was 6.5. The enzyme activity of CSF increased, depending on the incubation temperature, ranging from 25° to 45°C. Ethyleneglycol tetra-acetic acid (1 mM) was found to inhibit PAF acetylhydrolase activity in CSF obtained from patients with SAH. Unaltered PAF acetylhydrolase activity was inhibited by adding an aliquot of CSF and minimum PAF acetylhydrolase activity decreased following SAH. Two peaks of inhibitory activity were detected on Sephacryl S-200 HR gel filtration: one was eluted in void volume and the other with an apparent molecular mass of 13 kD. The inhibitory activity was very labile and was lost completely within 3 days of incubation at 4°C. The regulation of the PAF concentration in the CSF of SAH patients is discussed.
Recurrence of ICA-PCoA aneurysms after neck clipping
Authors: Sakaki Toshisuke , Takeshima Toshikazu , Tominaga Masao , Hashimoto Hiroshi , Kawaguchi Shoichiro
Published: May 2009

✓ Between 1975 and 1992, 2211 patients underwent aneurysmal neck clipping at the Nara Medical University clinic and associated hospitals. The aneurysm in 931 of these patients was situated at the junction of the internal carotid artery (ICA) and posterior communicating artery (PCoA). Seven patients were readmitted 4 to 17 years after the first surgery because of regrowth and rupture of an ICA-PCoA aneurysmal sac that had arisen from the residual neck. On angiograms obtained following aneurysmal neck clipping, a large primitive type of PCoA was demonstrated in six patients and a small PCoA in one. A small residual aneurysm was confirmed in only two patients and angiographically complete neck clipping in five. Recurrent ICA-PCoA aneurysms were separated into two types based on the position of the old clip in relation to the new growth. Type 1 aneurysms regrow from the entire neck and balloon eccentrically. In this type, it is possible to apply the clip at the neck as in conventional clipping for a ruptured aneurysm. Type 2 includes aneurysms in which the proximal portion of a previous clip is situated at the corner of the ICA and aneurysmal neck and the distal portion on the enlarged dome of the aneurysm, because the sac is regrowing from a portion of the residual neck. In this type of aneurysm, a Sugita fenestrated clip can occlude the residual neck, overriding the old clip. Classifying these aneurysms into two groups is very useful from a surgical point of view because it is possible to apply a new clip without removing the old clip, which was found to be adherent to surrounding tissue.
Surgical management of cavernous malformations of the third ventricle
Authors: Katayama Yoichi , Tsubokawa Takashi , Maeda Tsuyoshi , Yamamoto Takamitsu
Published: May 2009

✓ In order to determine adequate therapeutic approaches for cavernous malformations of the third ventricle, the authors reviewed a series of five such malformations managed at their institution and nine others reported in the literature. Four subgroups were identified in terms of the site of origin and could be characterized by different clinical manifestations: visual field defects and endocrine function deficits in patients with malformations in the suprachiasmatic region (six cases); symptoms caused by hydrocephalus in those with malformations in the foramen of Monro region (five cases); and deficits of short-term memory in those with malformations in the lateral wall (two cases) or of the floor of the third ventricle (one case). Unlike cavernous malformations at other locations, malformations of the third ventricle frequently demonstrated rapid growth (43%) and mass effects (71%). The surgical or autopsy findings suggested that the growth was attributable to repeated intralesional hemorrhages. Extralesional hemorrhage was also not uncommon, occurring in 29% of patients. Such tendencies require the adoption of a more aggressive approach to this particular group of cavernous malformations as compared to those in other locations. The risks of regrowth and extralesional hemorrhage appear to be reduced only by complete excision. The surgical approaches adopted should be aimed at providing the best access to the site where the malformation has arisen. The translamina terminalis approach for cavernous malformations in the suprachiasmatic region, the transventricular or transcallosal interfornicial approaches for those in the foramen of Monro region and the transvelum interpositum approach for those in the lateral wall or the floor of the third ventricle appear to be appropriate. In order to select the adequate surgical approach, precise diagnosis of the site of origin is crucial. In addition to neuroimaging techniques, the patient's initial symptoms provide valuable information.
Intraoperative angiography in the resection of arteriovenous malformations
Authors: Anegawa Shigetaka , Hayashi Takashi , Torigoe Ryuichiro , Harada Katsuhiko , Kihara Shun-ichi
Published: May 2009

✓ Surgical resection of 13 operatively obscure arteriovenous malformations (AVM's) was accomplished with the assistance of intraoperative angiography, which was performed stereographically to provide three-dimensional orientation and was repeated until total resection of the AVM was confirmed. All films obtained were subtracted to improve clarity. The method presented here may be useful for the resection of all types of AVM. Only two patients had residual AVM after the initial operation. No complications attributable to angiography were noted.
DNA index and S-phase in primary brain tumors
Authors: Vavruch Ludek , Eneström Sverker , Carstensen John , Nordenskjöld Bo , Wingren Sten
Published: May 2009

✓ Forty-nine primary intracranial tumors (33 astrocytomas, eight acoustic schwannomas, five oligodendrogliomas, and three miscellaneous tumors) were studied by flow cytometry. Each tumor specimen was divided into two portions: one was studied as an unfixed suspension stained with propidium iodide and the other after formalin fixation and paraffin embedding. The 50-µm sections from the paraffin blocks were deparaffinized, rehydrated, and enzymatically disintegrated, and the cells in suspension were stained with propidium iodide. Flow cytometry of the two portions showed a significant correlation between fresh and fixed specimens regarding the S-phase (r = 0.87) and a very close correlation of the deoxyribonucleic acid (DNA) index (r = 0.95). When the 33 astrocytomas were analyzed separately, similar results were obtained (r = 0.86 for S-phase and r = 0.93 for DNA index, respectively).

This study demonstrated a high correlation between fresh and fixed specimens for DNA ploidy and S-phase both in primary intracranial tumors in general and also in the selected subgroup of astrocytomas.
The relationship between traumatic brain injury-induced changes in brain temperature and behavioral and anatomical outcome
Authors: Weisend Michael P. , Feeney Dennis M.
Published: May 2009

✓ Alteration of brain temperature, experimentally induced or spontaneous, has been shown to affect the symptoms resulting from a variety of cerebral insults. This study examined the effect of traumatic brain injury (TBI) on brain and body temperature in rats and the relationship between TBI-induced temperature changes, neuropathology, and behavioral recovery. Anesthesia, surgery and TBI all caused changes in brain and body temperatures. The level of brain (but not body) temperature at the time of TBI was positively correlated with the severity of hippocampal and thalamic pathology. In contrast, the measured levels of both brain and body temperatures after TBI were not related to behavioral or neuroanatomical outcome. Interestingly, the increase in brain (but not body) temperature from the time of TBI to 5 to 10 minutes after termination of anesthesia was negatively correlated with behavioral and anatomical outcome. Simply stated, the more rapidly brain temperature returned toward normal, the better the rats' behavioral and anatomical outcome. This rate of return toward normal brain temperature is not interpreted as causally related to outcome but rather as an index of the severity of brain injury.
Coccidioidomycotic brain abscess
Authors: Mendel Ehud , Milefchik Eric N. , Ahmadi Jamshid , Gruen Peter
Published: May 2009

✓ Coccidioidomycosis is an infection originating in the San Joaquim Valley of southern California, but now seen with increasing frequency throughout southern California and the southwestern United States. Central nervous system involvement is usually manifested as meningitis.

The authors present the case of a young man with pulmonary coccidioidomycosis who developed a brain lesion that proved to be a coccidioidomycotic abscess. With the increasing incidence of the disease, this manifestation may be encountered more often and should therefore be included in the differential diagnosis of any patient from an endemic area who presents with a brain mass.
Low clinical ischemic threshold for cerebral blood flow in severe acute brain trauma
Authors: Cruz Julio
Published: May 2009

✓ A case of severe acute brain trauma is presented in which the patient made a satisfactory recovery after suffering a marked reduction in cerebral blood flow, to a level previously reported in association with impending brain death (10 ml/100 gm/min). This is believed to be the first report of a patient with severe acute brain injury in whom serial clinical and physiological assessments allowed documentation of the reversibility of such a critical level of cerebral hypoperfusion.
Giant cell tumor of the calvaria in a child
Authors: Reed Lee , Willison Crystl D. , Schochet Sydney S. , Voelker Joseph L.
Published: May 2009

✓ A giant cell tumor involving the vertex of the skull is described in a 3-year-old child with no history of head trauma. The mass was present approximately 4 months prior to resection. Microscopically, the lesion consisted of highly cellular tissue composed of oval to spindle-shaped stromal cells admixed with numerous multinucleated giant cells.

Giant cell tumor of the skull is a rare lesion, usually involving the sphenoid or temporal bone in adults. The differential diagnosis is discussed with reference to the literature regarding giant cell lesions, especially of the cranium. The authors are unaware of previous reports of a similar lesion in this location in such a young child.
Mobile sediment of CaCO3 grains inside the cyst of an intraventricular teratoma
Authors: Iseda Tsutomu , Yamakawa Yuzo , Asami Naoki , Morisako Toshitaka , Oku Takamitu , Uwada Osamu , Toyoda Kiyokazu
Published: May 2009

✓ The case of a 40-year-old woman with a mature cystic teratoma in the lateral ventricle is reported. An unusual mobile sediment of radiopaque material in the cyst was identified as grains of calcium carbonate. It was considered to have precipitated from the cystic fluid under specific chemical conditions.
A long-term outcome analysis of 984 surgically treated herniated lumbar discs
Authors: Davis Richard A.
Published: May 2009

✓ This paper presents a long-term follow-up study of 984 patients operated on for a herniated lumbar disc between 1959 and 1991. It was possible to follow 98% of patients from the time of operation to the time of writing. The mean follow-up period was 10.8 years. The most common presenting complaint was back pain with sciatica in one leg; the most frequent neurological finding was impaired straight-leg raising. Myelography confirmed the diagnosis in 80% of patients, but more recently enhanced computerized tomography and magnetic resonance imaging have been the preferred studies. The operative procedure was either hemilaminectomy or laminectomy with × 3.5 magnification and fiberoptic lighting. Herniated lumbar discs involved L4–5 and L5–S1 with equal frequency (47%). The recurrence rate was 6%, one-third of which developed during the 1st year after operation. The complication rate was 4%; there were no intraoperative vascular or intestinal injuries. The Prolo Functional Economic Outcome Rating Scale was used to measure long-term outcome and the results were compared to those of Pappas,et al.Patients who did sedentary work and housewives had statistically higher total and economic Prolo scores (p < 0.01) than those who did strenuous work. The majority of patients with the “failed-back syndrome” had pending legal or Workers' Compensation claims, or were at psychological risk for surgery. In 89% of patients the outcome was good — defined as a Prolo score of 8 in 10%, 9 in 19%, and 10 in 60%.
Intracranial meningiomas of the first two decades of life
Authors: Germano Isabelle M. , Edwards Michael S. B. , Davis Richard L. , Schiffer Davide
Published: May 2009

✓ Meningiomas arising in the first two decades of life are uncommon and their characteristics are controversial. Some authors believe meningiomas in younger patients occur in different locations, have more malignant histological features, and have a worse prognosis than those in adults. To address this controversy, the authors retrospectively reviewed 23 cases of meningiomas in patients under 21 years of age at diagnosis who were operated on at the University of Turin (1948 to 1990) or at the University of California, San Francisco (1970 to 1989). These tumors represented 2.9% of all tumors in this age group and 1.8% of all meningiomas during the study period at the two institutions. There were 14 males and nine females. The mean age at surgery was 13.3 ± 5.6 years; nine cases occurred in the first decade and 14 in the second. The most common neurological symptoms were a focal neurological deficit (33%) and seizures (25%). Seventy percent of the tumors were supratentorial. A gross total resection was performed in 60% of the cases. Histologically, the majority (74%) of the tumors were meningothelial or mixed. An increased number of mitoses was observed in 33% of the tumors, focal necrosis in 29%, and invasion of adjacent brain in 14%; however, none of the tumors was classified as a Grade III (anaplastic) meningioma. All patients are alive without evidence of recurrent disease 3 to 22 years (mean ± standard deviation: 10 ± 7.3 years) after surgery. This study confirms the rarity of meningiomas of the first two decades of life and the absence of the female predominance associated with meningiomas in adults. The location and histological features of these tumors are similar to those in adults; they have a low recurrence rate, and the outcome and survival rate are excellent.
Symptomatic glial cysts of the pineal gland
Authors: Fain Jonathan S. , Tomlinson Francis H. , Scheithauer Bernd W. , Parisi Joseph E. , Fletcher Geoffrey P. , Kelly Patrick J. , Miller Gary M.
Published: May 2009

✓ Small asymptomatic cysts of the pineal gland represent a common incidental finding in adults undergoing computerized tomography or magnetic resonance (MR) imaging or at postmortem examination. In contrast, large symptomatic pineal cysts are rare, being limited to individual case reports or small series. The authors have reviewed 24 cases of large pineal cysts. The mean patient age at presentation was 28.7 years (range 15 to 46 years); 18 were female and six male. Presenting features in 20 symptomatic cases included: headache in 19; nausea and/or vomiting in seven; papilledema in five; visual disturbances in five (diplopia in three, “blurred vision” in two, and unilateral partial oculomotor nerve palsy in one); Parinaud's syndrome in two; hemiparesis in one; hemisensory aberration in one; and seizures in one. Four lesions were discovered incidentally. Magnetic resonance imaging typically demonstrated a 0.8- to 3.0-cm diameter mass (mean 1.7 cm) with homogeneous decreased signal intensity on T1-weighted images, increased signal intensity on T2-weighted images, and a distinct margin. Hydrocephalus was present in eight cases. The cysts were surgically excised via an infratentorial/supracerebellar approach (23 cases) or stereotactically biopsied (one case). Histological examination revealed a cyst wall 0.5 to 2.0 mm thick comprised of three layers: an outer fibrous layer, a middle layer of pineal parenchymal cells with variable calcification, and an inner layer of hypocellular glial tissue often exhibiting Rosenthal fibers and/or granular bodies. Evidence of prior hemorrhage, mild astrocytic degenerative atypia, and disorganization of pineal parenchyma were often present. Postoperative follow-up review in all 24 cases (range 3 months to 10 years) revealed no complications in 21, mild ocular movement deficit in one, gradually resolving Parinaud's syndrome in one, and radiographic evidence of a postoperative venous infarct of the superior cerebellum with ataxia of 1 week's duration in one. Of the patients referred for study, the cysts were most often initially misdiagnosed as a pineocytoma in eight and a pilocytic astrocytoma in three. Only two patients were correctly diagnosed as having pineal cysts. This stresses the importance of recognizing the histopathological spectrum of pineal cysts, as well as correlation with radiographic findings, if a correct diagnosis is to be attained.
Anaerobic glycolysis preceding white-matter destruction in experimental neonatal hydrocephalus
Authors: Chumas Paul D. , Drake James M. , Del Bigio Marc R. , Da Silva Marcia , Tuor Ursula I.
Published: May 2009

✓ The metabolic changes in neonatal hydrocephalus that lead to permanent brain injury are not clearly defined, nor is the extent to which these changes can be prevented by a cerebrospinal fluid shunt. To clarify these processes, cerebral glucose utilization was examined using [14C]2-deoxyglucose autoradiography in 1-month-old kittens, kaolin-induced hydrocephalic littermates, and hydrocephalic kittens in which a ventriculoperitoneal shunt had been inserted 10 days after kaolin injection. The hydrocephalic kittens showed thinning of the cerebral mantle and an anterior-to-posterior gradient of enlargement of the ventricular system, with a ventricle:brain ratio of 24% for the frontal and 35% for the occipital horns compared with control (< 0.5%) and shunted (< 5%) animals. White matter in hydrocephalic animals was edematous. Myelination was delayed in the periventricular region and in the cores of the cerebral gyri.

Glucose utilization in hydrocephalic and shunted animals was unchanged from control animals in all gray-matter regions examined. However, in hydrocephalic animals, the frontal white matter exhibited a significant increase in glucose utilization (25 µmol • 100 gm−1• min−1) in the cores of gyri compared with normal surrounding white-matter values (14.8 µmol • 100 gm−1• min−1). Very low values (mean 4 µmol • 100 gm−1• min−1) were found in areas corresponding to severe white-matter edema, and these areas were surrounded by a halo of increased activity (24 µmol • 100 gm−1• min−1). In contrast, cytochrome oxidase activity in white matter was homogeneous. Shunting resulted in restoration of the cerebral mantle thickness, a return to normal levels of glucose utilization in the white matter, and an improvement in myelination.

It is suggested that the areas of increased glucose utilization seen in the white matter represent anaerobic glycolysis which, if untreated, progresses to infarction. The pattern of this increased glucose utilization matches that of expected myelination and, during this period of high energy demand, white matter may be susceptible to the hypoperfusion associated with hydrocephalus.
Liposomal transfection of human γ-interferon gene into human glioma cells and adoptive immunotherapy using lymphokine-activated killer cells
Authors: Mizuno Masaaki , Yoshida Jun , Takaoka Toru , Sugita Kenichiro
Published: May 2009

✓ The authors evaluated the effect of liposomal transfection of human γ-interferon (HuIFN-γ) gene into human glioma cells and lymphokine-activated killer (LAK) cells, alone and in combination. An HuIFN-γ; gene inserted in a eukaryotic expression vector was entrapped in liposomes bearing positive surface charges. Liposomal gene transfection induced production of HuIFN-γ and its secretion in culture medium of human glioma cell lines (SK-MG-1 and U-251 MG). At 4 days after transfection, the cells produced 10 to 50 U/ml of HuIFN-γ in the medium, whereby the major histocompatibility complex (MHC) class I and II antigens, as well as intercellular adhesion molecule-1 (ICAM-1), were induced on the glioma cell surface. The growth-inhibiting effect of transfection-induced HuIFN-γ; was much stronger in comparison with control cultures exposed to 500 U/ml of exogenously added HuIFN-γ;. In addition, 20% to 40% growth inhibition was obtained in the glioma cells when they were treated with LAK cells alone at a 5:1 ratio of effector to target cells. Liposomal transfection of HulFN-γ; gene into human glioma cells combined with immunotherapy using LAK cells was more effective than either technique alone. The reinforcement of growth inhibition in the case of combined therapy was quenched by anti-ICAM-I monoclonal antibody, but not by anti-MHC class I or II monoclonal antibodies. These results suggest that the combined effect of liposomal transfection of HuIFN-γ; gene plus LAK cells into human glioma cells is a potentially useful therapy for malignant glioma, and that the mechanisms of the reinforcement of growth inhibition are closely related to the expression of ICAM-I on the glioma cell surface.
Basement membrane invasion of glioma cells mediated by integrin receptors
Authors: Paulus Werner , Tonn Jörg C.
Published: May 2009

✓ Basement membrane invasion precedes meningeal dissemination and systemic metastasis of glioma cells. In order to investigate the invasive ability of glioblastomas and the functional role of extracellular matrix receptors, the authors performed in vitro invasion assays where the number of cells was determined from freshly resected tumors (primary cultures and fifth passages) and from cell lines (U-138 MG, U-373 MG, and GaMg) that had migrated through a filter coated with a reconstituted basement membrane (Matrigel). The involvement of integrin adhesion molecules was examined by preincubation of glioma cells with blocking antibodies to specific integrin chains. Cells from all of the glioblastomas had migrated through the Matrigel after 4 to 24 hours; the number of invasive cells was highest in the cell lines. Invasion of U-138 MG cells was reduced with antibodies to α7, αv, β1, and β3 integrin chains and markedly increased by anti-α5, while invasion of U-373 MG cells was reduced by antibodies to α3, αv, β1, and β3 and increased by anti-α6. It is concluded that: 1) glioma cells are able to penetrate Matrigel, indicating that the basement membrane is not a resistant barrier for infiltrating cells; and 2) basement membrane invasion is mediated by integrins in a complex manner. Some integrins promote while others inhibit basement membrane invasion. Furthermore, the integrins involved may differ between various glioma cells.
Interface between the facial nerve and large acoustic neurinomas Immunohistochemical study of the cleavage plane in NF2 and non-NF2 cases
Authors: Jääskeläinen Juha , Paetau Anders , Pyykkö Ilmari , Blomstedt Göran , Palva Tauno , Troupp Henry
Published: May 2009

✓ In acoustic neurinoma surgery, the surgeon is required to find a cleavage plane between the facial nerve and the tumor, and with the aid of the operating microscope this is usually achieved by fine dissection. A histological specimen of the nerve-tumor interface is available only if the facial nerve was hopelessly adherent to the tumor (usually a large or giant neoplasm) and the surgeon decided to sever the nerve to obtain a complete removal. The authors have examined immunohistochemically the nerve-tumor interface of 20 such facial nerves (six cases of neurofibromatosis 2 (NF2) and 14 of non-NF2) in a series of 351 acoustic neurinomas. The largest extrameatal dimension of the 20 tumors ranged from 20 to 51 mm (median 39 mm). In all of these 20 instances the nerve-tumor contact area was at least partially devoid of a clear-cut histological cleavage plane. Where the facial nerve trunk was attached to the surface of the tumor, nerve fibers of the contact areas either abutted directly against tumor cells or nerve fibers were seen to penetrate into the tumor tissue. Frank embedding of nerve fibers was more frequent in NF2.
Cervical conjoined nerve root variant: preoperative imaging and surgical confirmation
Authors: Chu Constance R. , Chesnut Randall M.
Published: May 2009

✓ A case of a nerve root anomaly in a patient presenting with cervical radiculopathy is presented. The patient was treated with posterolateral exploration and decompression, resulting in relief of pain and improvement in strength. Both the preoperative contrast-enhanced computerized tomography scan and the magnetic resonance image demonstrated an abnormality behind the C-4 body extending from the right C3–4 neural foramen to the neural foramen at C4–5. At surgery, a dural-encased structure was discovered connecting the C-4 and C-5 nerve roots within the spinal canal. This paper describes the first reported case of a cervical nerve root anomaly of this type, representing a variant of a conjoined nerve root. The occurrence of such nerve root anomalies in the cervical spine should be entered into the differential diagnosis and treatment of cervical radiculopathy.
Coexistent trigeminal neuralgia, hemifacial spasm, and hypertension: preoperative imaging of neurovascular compression
Authors: Ballantyne Eric S. , Page Rosalind D. , Meaney James F. M. , Nixon Thomas E. , Miles John B.
Published: May 2009

✓ The case is reported of a 60-year-old woman with left-sided trigeminal neuralgia, hemifacial spasm, and hypertension. Compression of the left trigeminal, facial, and vagus nerves by the anterior and posterior inferior cerebellar arteries and a persistent trigeminal artery variant were demonstrated by magnetic resonance angiography using a novel sequence. At operation the angiographic appearances were confirmed, and decompression was performed with the placement of polyvinyl sponge at all three levels. Postoperatively, the patient had complete relief from the trigeminal neuralgia and hemifacial spasm and has sustained normotension without medication.
Decompression for dysthyroid ophthalmopathy via the orbital rim approach
Authors: Elisevich Kost , Allen Larry , Bite Uldis , Colcleugh Robert
Published: May 2009

✓ A technique is described wherein the approach to the orbital cavity, with resection of its roof and lateral wall, is facilitated by a single burr hole and local en bloc removal of the lateral and supraorbital margins. A satisfactory decompression with reduction of proptosis of the orbital contents and a good cosmetic result is achieved without the need for a large dural exposure. The approach may be combined with removal of the anterior wall of the frontal sinus in cases where the lateral aspect extends appreciably laterally. Access to the orbital roof and lateral wall is straightforward and can be coupled with further removal of the floor lateral to the infraorbital nerve and medial wall. Advancement of the orbital rim upon bone replacement adds to orbital volume, creating better mechanical advantage for eyelid closure.
John F. Fulton, M.D., and the founding of the Journal of Neurosurgery
Authors: Davey Lycurgus M.
Published: May 2009

✓ The Journal of Neurosurgery, although the idea of a Chilean neurosurgeon, Alfonso Asenjo, was the product of a well-placed and energetic charter member of the Harvey Cushing Society, John F. Fulton. In the researched files the first formal correspondence is that of Asenjo dated May 20, 1943. When he received Paul Bucy's encouraging reply of June 19, 1943, he promptly betook himself to New Haven, where he spent July 3 and 4 with Fulton. Within a week of that visit, Fulton was writing to the Executive Committee of the Harvey Cushing Society recommending the establishment of such a journal. Fulton contacted his friend and publisher, Charles C. Thomas, and by the end of October he was meeting with representatives of the Banta Publishing Company to discuss matters relating to the printing of the Journal of Neurosurgery, in particular, the scarcity of paper. The twin problems of shortages of paper and financing were soon resolved under the guidance of Thomas, but other details remained. Thus, the first issue, scheduled to appear in January, 1944, was not mailed until the middle of March of that year, but thereafter a regular bimonthly schedule was maintained. While Asenjo should be given proper credit for the idea, this essay confirms the validity of Bucy's listing: “John F. Fulton — Founder (1944).”
Reflections upon the nature and management of intracranial and intraspinal vascular malformations and fistulae
Authors: Mullan Sean
Published: May 2009

✓ Evidence is presented that dural fistulae are preceded by sinus thrombosis and that their danger lies in arterialized venous pressure within the cranium or the orbit. Arterial side occlusion leads to recurrence, while venous side occlusion leads to permanent cure. Vein of Galen aneurysms embrace some features of cerebral arteriovenous malformations (AVM's), namely a reticulum, and some features of dural fistulae, namely evidence of previous sinus anomaly and direct drainage into a sinus. These aneurysms are also permanently cured by venous side thrombosis, although the dangers inherent in their reticulum demand that this be done in stages or preceded by arterial side embolization. A very limited experience with venous end occlusion of cerebral (and spinal) AVM's suggests that they, too, can be permanently cured by venous side occlusion without excision. Their reticulum demands maximum, multistage, preliminary arterial side embolization together with intraoperative hypotension during the venous occlusion stage in order to minimize intracerebral hemorrhage or swelling.

Schematic models of both fistulae and malformations are presented, together with reasons why particulate embolization is safer than glue embolization. The theory is advanced that dural fistulae, vein of Galen aneurysms, and AVM's are venous- rather than arterial-based lesions, which is consistent with the experience that permanent cure has been effected by venous side occlusion without excision in all three anomalies. It is speculated that there may be a developmental link between AVM and the venous malformation, the AVM being essentially a fistulized venous malformation.
Multiple clipping technique for large and giant internal carotid artery aneurysms and complications: angiographic analysis
Authors: Tanaka Yuichiro , Kobayashi Shigeaki , Kyoshima Kazuhiko , Sugita Kenichiro
Published: May 2009

✓ Experience with surgical clipping of 16 large and nine giant aneurysms of the intradural internal carotid artery (ICA) is described. Reconstruction of the parent artery with part of the aneurysmal wall was necessary in the majority of cases. Multiple clips were required for satisfactory clipping in 20 cases. Complications related to the clipping procedure comprised occlusion and stenosis of the parent carotid artery in isolated cases. Straightening of the parent carotid artery with consequent kinking of the middle cerebral artery was seen in three cases of an aneurysm with a dome directed ventrally in the proximal segment of the ICA. The factors that caused straightening of the ICA are analyzed. It was observed that an excessive change in the direction of the ICA can cause cerebral infarction.
Surgery for paraclinoidal carotid artery aneurysms
Authors: Batjer H. Hunt , Kopitnik Thomas A. , Giller Cole A. , Samson Duke S.
Published: May 2009

✓ Aneurysms arising from the proximal carotid artery between the roof of the cavernous sinus and the origin of the posterior communicating artery pose conceptual and technical surgical problems with regard to acquisition of proximal control and safe intracranial exposure. Over the past 3½ years, 89 patients with paraclinoidal aneurysms have been treated at the University of Texas Southwestern Medical Center. Thirty-nine (44%) of these patients presented with subarachnoid hemorrhage. A total of 149 aneurysms and six arteriovenous malformations have been identified in this patient group such that 38 (43%) of the patients suffered multiple vascular anomalies. Temporary artery occlusion has been employed during operation in 48 cases (54%), permanent carotid artery occlusion in four (4%), and hypothermic circulatory arrest in two (2%). Twenty-two patients harbored giant aneurysms, seven of which had ruptured. Outcome was considered good in 77 patients (86.5%), fair in eight (9%), and poor in three (3%); one patient died.

This concentrated experience permitted a practical anatomical grouping of aneurysms into three types: carotid-ophthalmic artery aneurysms with a superior or superomedial projection (44 cases); superior hypophyseal aneurysms with a medial or inferomedial projection (26 cases); and proximal posterior carotid artery wall aneurysms projecting posteriorly or posterolaterally (19 cases). Despite the fact that paraclinoidal aneurysms often disobey the traditional teachings of aneurysm development, having no vessel of origin or clear hemodynamic cause, this practical grouping has allowed individualized and focused operative approaches unique to each aneurysm projection with good visual function and outcome in most patients.
Diffuse brain swelling after head injury: more often malignant in adults than children?
Authors: Lang Dorothy A. , Teasdale Graham M. , Macpherson Peter , Lawrence Audrey
Published: May 2009

✓ A series of 118 patients with diffuse traumatic brain swelling was studied retrospectively in order to compare the clinical findings in children with those in adults, and to determine the occurrence of neurological deterioration and outcome. The computerized tomography (CT) picture of absent third ventricle and basal cisterns was used to identify the cases. Although this condition has been associated with children, we found the same number of children and adults (59 cases each). Secondary deterioration (decline in consciousness, the development of new focal neurological signs, or an increase in intracranial pressure) occurred in 40% of cases and was more common in adults than children. Features that were significantly associated with deterioration were the presence of prolonged coma (> 1 hour) after the injury, CT signs of diffuse axonal injury or subarachnoid hemorrhage, or a recorded episode of hypotension. A moderate or good recovery at 6 months was achieved by 70 patients (59%), but 45 patients had a poor outcome (severe disability in nine, vegetative state in three, and death in 33) and this was often a consequence of secondary deterioration. In three patients, the outcome was not known. The combination of a severe initial injury, secondary insult, and diffuse swelling is associated with a poor outlook, particularly in adults. The CT appearance of diffuse swelling may develop more readily in children because of the lack of cerebrospinal fluid available for displacement. In children, diffuse swelling may have a relatively benign course unless there is a severe primary injury or a secondary hypotensive insult.
Distinctive electrophysiological characteristics of functionally discrete brain areas: a tenable approach to functional localization
Authors: Goldring Sidney , Harding Gary W. , Gregorie Erik M.
Published: May 2009

✓ The direct cortical response (DCR), an electrical potential recorded in the immediate vicinity of a surface cortical stimulus, shows a configuration in the primary sensory areas of animals that is different from the one observed in association cortex. This suggested the possibility that systematic study of the DCR in the human brain might reveal a profile of configurations in which the form of the response provides functional information about the gyri being tested.

Studies were carried out in subhuman primates and in patients undergoing surgery for tumors, occult vascular malformations, and epilepsy. In the animals, DCR's from somatosensory, motor, and association cortex are distinguishable; however, there are no differences in configuration between motor and premotor responses, or between association responses from prefrontal and parietal cortex. In patients with epilepsy due to nonspace-occupying pathology, the responses did not show distinguishing features. In contrast, in the patients with tumors or occult vascular malformations, DCR's from somatosensory, motor, and premotor cortex could be readily distinguished from each other. Responses along the mid and posterior sylvian fissure of the dominant hemisphere also had distinctive features, but more data are needed before the significance of this finding with respect to language function can be assessed. The accumulating results suggest that analysis of DCR's may prove to be a useful method for functional localization in individuals with focal space-taking pathology.
Meningioangiomatosis of the brain stem
Authors: Kollias Spyros S. , Crone Kerry R. , Ball William S. , Prenger Erin C. , Ballard Edgar T.
Published: May 2009

✓ The case is reported of meningioangiomatosis of the brain stem in a 3½-year-old girl who suffered from vomiting, left facial weakness, difficulty in swallowing, and ataxia. This is believed to be the first reported case of meningioangiomatosis in the brain stem. Computerized tomography showed an intensely enhancing hyperdense mass in the left restiform body. Magnetic resonance imaging revealed that the lesion was isointense to gray matter on the T1-weighted image and hypointense on the T2-weighted image, with a surrounding zone of high T2 signal and intense enhancement. Angiography was normal. Surgical exploration demonstrated an intramedullary firm mass that was partially resected. Histologically, the mass consisted of a low-grade lesion of meningeal origin with spindle cells in a whorling pattern that were occasionally focused around small vessels. On 2-year follow-up imaging, the lesion remains unchanged in size. Certain particularities of this lesion are discussed in the context of the literature.
Erythropoietin-augmented isovolemic hemodilution in skull-base surgery
Authors: Kantrowitz Allen B. , Spallone Aldo , Taylor William , Chi T. Linda , Strack Margery , Feghali Joseph G.
Published: May 2009

✓ Human erythropoietin in concert with intraoperative hemodilution, tumor embolization, and surgical staging was used to manage a red blood cell mass in an anemic Jehovah's Witness patient with a hypervascular meningioma. Erythropoietin (3000 U thrice weekly) and oral iron (1300 mg daily) were given for 1 month prior to surgery, raising the hemoglobin level from 11.8 to 14.1 gm/100 ml. A posterior fossa craniectomy combined with a temporal craniectomy was then performed so that partial petrosectomy, section of the transverse sinus, incision of the tentorium, and exposure of the lesion could be carried out. The first stage of the surgery was terminated immediately prior to tumor mobilization. Isovolemic hemodilution was initiated just before the skin incision.

Postoperatively, the hemoglobin concentration dropped to 11.5 gm/100 ml. The erythropoietin dose was doubled and administration of oral iron continued, leading to a hemoglobin level of 14.0 gm/100 ml at 1 month after the first operation. The tumor was embolized using superselective catheterization. The next day, at the second stage of the surgery, the tumor was extirpated, again employing isovolemic hemodilution. By the 4th postoperative day, the hemoglobin level had dropped to 9.4 gm/100 ml. The patient made an uncomplicated recovery.

Erythropoietin therapy contributed substantially to the successful outcome of this case. Since erythropoietin has the potential to augment all other forms of autologous banking, its role in elective neurosurgery may become increasingly important in an era of heightened concern about heterologous transfusion.
A simple method to ensure proper screw position and plate size selection using the Morscher cervical spine locking plate
Authors: Ball Perry A. , Benzel Edward C. , Baldwin Nevan G.
Published: May 2009

✓ The use of bone plate instrumentation with screw fixation has proved to be a useful adjunctive measure in anterior cervical spine fusion surgery. Proper fitting, positioning, and attachment of this instrumentation have been shown to be frequently suboptimal if done without radiographic guidance. The most commonly used method of radiographic assistance for placement of this instrumentation is fluoroscopy. While this gives satisfactory technical results, it is expensive and time-consuming, and exposes the patient and the operating room personnel to ionizing radiation. The authors present a simple technique to ensure screw placement and plate fitting using Kirschner wires and a single lateral radiograph. This technique saves time, reduces exposure to radiation, and has led to satisfactory results in over 20 operative cases.
The treatment of posttraumatic tremor by stereotactic surgery
Authors: Krauss Joachim K. , Mohadjer Mohsen , Nobbe Fritz , Mundinger Fritz
Published: May 2009

✓ The authors report the long-term results of stereotactic surgery for severe posttraumatic appendicular tremor in 35 patients. The tremors developed after severe head trauma in 33 patients (94%) and after mild to moderate head trauma in two (6%). In all but one, the tremor was most evident during activity. The amplitude of the kinetic tremor was greater than 5 cm in 33 patients (94%) and greater than 12 cm in 19 patients (54%). All were severely incapacitated in their daily living activities due to the tremors. The 35 patients underwent 42 stereotactic operations; five patients were reoperated on the same side and two were treated with a bilateral staged procedure. The contralateral zona incerta was the stereotactic target in 12 patients and was targeted in combination with the base of the ventrolateral (oroventral) thalamus in 23 patients.

Long-term postoperative follow-up review was obtained in 32 patients (mean follow-up period 10.5 years). Persistent improvement of tremor was noted in 88%. The tremor was absent or markedly reduced in 65%. Functional disability was assessed and quantified with a modified form of an established rating scale for patients with tremor; it was reduced from a mean value of 57% of maximum disability to 37% over the long term (p < 0.001). Follow-up lesion assessment was obtained in 18 patients by multiplanar magnetic resonance imaging and at autopsy in one patient whose death was unrelated to surgery. As in previous studies, the frequency of persistent side effects was relatively high (38%). These consisted mainly of aggravation of preoperative symptoms. The results are compared to those of a total of 55 patients reported from 1960 to 1992. The occurrence of dystonia and dystonic postures is discussed. Stereotactic surgery is a powerful tool to alleviate posttraumatic tremor and to improve functional disability. However, as there is considerable risk of persistent morbidity in patients after severe head trauma, the operation should be restricted to selected cases with disabling tremor.
Enlarging solitary cysticercus granulomas
Authors: Rajshekhar Vedantam , Chandy Mathew J.
Published: May 2009

✓ Solitary cysticercus granulomas that produce seizures usually measure less than 20 mm in diameter and diminish in size spontaneously. Unlike live cysticercus cysts, they have not been known to increase in size. In a prospective follow-up study of 93 consecutive patients with epilepsy and small solitary lesions (< 20 mm in diameter) enhancing on computerized tomography (CT), 91 were found to have solitary cysticercus granuloma; of these, seven (7.7%) were diagnosed as having an enlarging cysticercus granuloma. Enlarging lesions were defined as those that, on follow-up CT, had increased by more than 50% of their original size but were still less than 20 mm in diameter (Group 1, three patients) or those that had increased to more than 20 mm (Group 2, four patients). Excision biopsy is recommended for Group 2 solitary lesions, regardless of the clinical progression, to eliminate the possibility of other pathologies. However, a trial of albendazole therapy with early CT re-evaluation (within 4 to 6 weeks) may be warranted in those with Group 1 lesions and in selected patients with Group 2 lesions. It is important to recognize the entity of enlarging solitary cysticercus granuloma to avoid mistaking it for a tuberculoma and treating the patient with empiric antituberculous therapy.
Preservation of hearing after surgery for acoustic schwannomas: correlation between cochlear nerve function and operative findings
Authors: Umezu Hiromichi , Aiba Tadashi
Published: May 2009

✓ The results of surgery in 66 patients with acoustic schwannoma in whom total tumor removal was accomplished are reviewed in terms of the relationships among tumor size, preoperative hearing level, operative findings (including the shape and location of the cochlear nerve at the tumor surface), and the extent of post-operative hearing preservation. Both tumor size and the preoperative hearing level were correlated with the shape of the cochlear nerve, which more frequently formed a solid bundle when the tumor was small or the preoperative hearing was excellent. Hearing was retained postoperatively only in cases in which the nerve formed a solid bundle and could be differentiated and separated from the tumor capsule without difficulty. These findings suggest that tumor size and preoperative hearing level, which have been reported to be the main prognostic factors of postoperative hearing preservation, may influence the results of surgery for acoustic schwannoma through the shape of the cochlear nerve.