bluuebunny/crossref_metadata_2025 huggingface dataset:
Cushing's disease with pituitary apoplexy leading to hypopituitarism, empty sella, and spontaneous fracture of the dorsum sellae
Authors: Gutin Philip H. , Cushard William G. , Wilson Charles B.
Published: May 2009

✓ A patient with a pituitary adenoma secreting adrenocorticotropin hormone manifested panhypopituitarism after an episode of pituitary apoplexy. The previously elevated urinary levels of 17-ketogenic steroids dropped sharply, and plasma cortisol became undetectable. The apoplexy also resulted in a partially empty sella on which the dorsum sellae collapsed. Recurrent Cushing's disease developed and was cured by transsphenoidal resection of a microadenoma.
Intracranial diverticulum of the frontal sinus as a complication of frontal craniotomy
Authors: Hayman L. Anne , Aldama-Luebbert Alfonso E. , Evans Robert A.
Published: May 2009

✓ A large air-filled intracranial extradural diverticulum of the frontal sinus mucosa was removed from the anterior cranial fossa of a 47-year-old man 2 years after fracture of the posterior sinus wall during craniotomy.
Peripheral nerve stimulation for pain relief using a multicontact electrode system
Authors: Nashold Blaine S. , Mullen John B. , Avery Roger
Published: May 2009

✓ A new electrode system for peripheral nerve stimulation is described. The electrodes are directly sutured to the nerve, eliminating rotational and compressive effects associated with cuff electrodes.
Development of a computerized microstereotaxic method for localization and removal of minute CNS lesions under direct 3-D vision
Authors: Shelden C. Hunter , McCann Gilbert , Jacques Skip , Lutes Harold R. , Frazier Robert E. , Katz Richard , Kuki Rudi
Published: May 2009

✓ The authors describe a novel stereotaxic method for the removal of minute lesions of the central nervous system (CNS). With the development and refinement of computerized tomography (CT), such small lesions can be detected by noninvasive (x-ray) scanning with computer processing of the data. Using a G E 7800 scanner system and a PDP 11/45 computer, data processing of various kinds is possible. Multiple computer programs have been developed to enhance regions of interest on CT scans by magnification, three-dimensional reconstruction, and digital processing. These data are then used to calculate a stereotaxic approach to a CNS lesion. A head fixation system has been devised to enable information transfer from a CT scan to the stereotaxic surgical system. Newly developed instruments are mounted on a micromanipulator for guidance at the operative site. These include stereo endoscopes with xenon arc illumination, a tissue expander for exposing the operative area, a radiation tracer probe, a rotary extractor, and instruments for operating and removal of blood from a small intracerebral hemorrhage. The micromanipulator for guiding the tactical instruments is, in turn, mounted on a stereotaxic guide mechanism which accurately defines all areas of the cranium in three-dimensional coordinates. The combination enables the site of the lesion, the three-dimensional coordinates of which have been located by CT scan, to be accurately approached by the stereotaxic guide/micromanipulator assembly.
Acoustic neurilemmoma
Authors: Kasantikul Vira , Netsky Martin G. , Glasscock Michael E. , Hays James W.
Published: May 2009

✓ Clinical data in 103 patients with acoustic neurilemmoma were correlated with anatomical findings. The tumors were more common in women. Peak prevalence was in the fifth and sixth decade without difference between the sexes. The neoplasms were divided into four sizes: small, medium, large, and giant. Small (intracanalicular) tumors occurred more often in men, were of equal frequency in the decades from 20 to 70 years, were generally associated with long duration of illness, were highly cellular, and had few blood vessels. They, therefore, differed from extracanalicular neurilemmomas, and are better considered as “minimal” rather than “early” tumors. Large and giant lesions occurred more often in women, were more heavily vascularized and collagenized, were more liable to bleed, contained fewer cells, and were often associated with symptoms of short duration. The length of illness ranged from 1 month with a 6-cm lesion, to 30 years with a 1-cm mass. It is suggested that although most tumors enlarge slowly, the rate of growth may vary widely. The unilateral acoustic neurilemmoma that rarely occurs in the first two decades of life may be a limited form of von Reckinghausen's disease. Mortality in this series was nil, and hence was unrelated to size of tumor as described in earlier reports. Angiomas were found in 24 schwannomas, and microscopic calcification in four. Vascular spaces resembling cysts often were formed by tumor cells. The histological development of acoustic neurilemmoma is hypothetically reconstructed.
Cerebrospinal fluid antibiotic levels during treatment of shunt infections
Authors: Wald Steven L. , McLaurin Robert L.
Published: May 2009

✓ Twenty patients with documented cerebrospinal fluid shunt infections were treated with daily intraventricular injections of methicillin, cephalothin, or gentamicin without removal of the shunt or external ventricular drainage. Periodic determinations of intraventricular antibiotic concentration revealed significant levels in relation to the established minimum inhibitory concentration in all cases.
Cardiac arrhythmias accompanying acute compression of the spinal cord
Authors: Evans Delbert E. , Kobrine Arthur I. , Rizzoli Hugo V.
Published: May 2009

✓ This study was undertaken to determine the cardiovascular response to compression of the spinal cord and to determine the autonomic mechanisms involved. The electrocardiogram and arterial blood pressure were recorded in anesthetized monkeys during inflation of a balloon catheter in the epidural space of the mid-thoracic region. Acute spinal cord compression resulted in a wide variety of severe cardiac arrhythmias and acute hypertension. The arrhythmias were found to result from hyperactivity of both the sympathetic and parasympathetic divisions of the autonomic nervous system.
Ineffectiveness of enzyme therapy on regeneration in the transected spinal cord of the rat
Authors: Guth Lloyd , Albuquerque Edson X. , Deshpande Sharad S. , Barrett Charles P. , Donati Edward J. , Warnick Jordan E.
Published: May 2009

✓ The potential clinical significance of the experiments of Matinian and Andreasian prompted repetition of their experiments. A laminectomy was made at T-5 or T-8 in 92 young female rats, and a fine wire probe was passed beneath the intact cord. The cord was then transected and the probe lifted through the incision so as to ensure the completeness of the transection. Rats were injected with various enzymes of American or Russian manufacture, including trypsin, hyaluronidase, elastase, elastase plus trypsin, or vehicle. At autopsy 4 to 6 months later, all rats were paraplegic. The stumps of the spinal cord were separated by cysts and a fibroglial scar. Nerve fibers did not cross the lesion site, nor was there conduction of nerve impulses across the site of injury. There were no significant behavioral, histological, or electrophysiological differences between any of the treatment groups.

Transection of the spinal cord was then performed in additional animals using Matinian and Andreasian's original surgical method (without passing a probe beneath the intact cord). Most of these rats began walking within 2 to 3 weeks, without enzyme therapy. Histological analysis revealed intact nerve fibers in the ventrolateral region of the spinal cord, indicating that the spinal cord had not been completely transected. It is concluded that: 1) enzyme treatment neither facilitates nerve regeneration nor permits functional restitution in rats with spinal cord transection; and 2) previously reported findings were apparently the result of incomplete spinal transection.
Servo-controlled lumbar infusions in children
Authors: Sklar Frederick H. , Beyer Chester W. , Ramanathan Murugappan , Clark W. Kemp
Published: May 2009

✓ Servo-controlled variable-rate lumbar infusions were performed in 11 children with presumed cerebrospinal fluid (CSF) absorptive defects. The CSF dynamics were determined as a function of intracranial pressure in terms of CSF absorptive capacity and resting pressure. These physiological measurements showed poor correlation with traditional clinical signs. On the basis of the CSF measurements there were four children with arrested hydrocephalus, one with compensated hydrocephalus, three with active hydrocephalus, and three with brain atrophy. Retrospective management decisions based on the clinical presentations, physical findings, and traditional diagnostic tests disagreed with management as indicated by the CSF measurements in eight of 11 cases. It is suggested that this technique may be a useful diagnostic tool for difficult clinical problems.
Diagnosis of empty sella syndrome using Amipaque cisternography combined with computerized tomography
Authors: Hoffman James C. , Tindall George T.
Published: May 2009

✓ A neuroradiological technique for demonstrating the empty sella syndrome using a low dose of intrathecally injected Amipaque (metrizamide) combined with computerized tomography scanning is described. Two case reports illustrating the potential value of the technique are presented. We have performed 55 cisternograms and have demonstrated the empty sella syndrome in six patients. The procedure is easier to perform and the morbidity is less than in pneumoencephalography.
A dynamic pressure study of spontaneous CSF rhinorrhea in the empty sella syndrome
Authors: Davis Stephen , Kaye Andrew H.
Published: May 2009

✓ The authors report a case of cerebrospinal fluid (CSF) rhinorrhea in a patient with the empty sella syndrome in whom continuous intracranial pressure (ICP) monitoring revealed intermittent peaks of raised ICP. Following a shunt procedure, ICP reverted to normal and the CSF rhinorrhea ceased for 10 weeks. The sella turcica was packed with muscle after the CSF rhinorrhea recurred.
Parenchymal cerebrospinal fluid extravasation as a complication of computerized tomography
Authors: Rekate Harold L.
Published: May 2009

✓ A case is presented in which neurological deterioration occurred during a computerized tomographic study. Total hemispheric dysfunction was seen in a patient with a postoperative suboccipital pseudomeningocele, whose head was wrapped in a compressive water bag. Cerebrospinal fluid was forced under pressure into the parenchyma of the right hemisphere, around a ventricular catheter. The neurological dysfunction resolved promptly with shunting.
Surgery of posterior communicating artery aneurysms that enlarge after common carotid ligation
Authors: Shiobara Ryuzo , Toya Shigeo , Mikouchi Shigemaru , Izumi Ziro
Published: May 2009

✓ Two patients are reported who were originally treated by ligation of the common carotid artery for ruptured aneurysms of the posterior communicating artery. Long-term follow-up studies showed that the aneurysms had enlarged, and direct surgery of the aneurysms was undertaken.
Tuberculoma of the anterior optic pathways
Authors: Iraci Giorgio , Giordano Renzo , Gerosa Massimo , Pardatscher Kurt , Tomazzoli Laura
Published: May 2009

✓ A tuberculoma, encasing the anterior optic pathways in a neoplastiform growth, was found in a 25-year-old man complaining of severe visual loss, diabetes insipidus, and sexual impotence following tuberculous meningitis. Following biopsy and anti-tuberculosis treatment, a satisfactory restoration of sight in one eye allowed the patient to resume an almost normal life.
Control of bone bleeding during Cloward procedure
Authors: Rengachary Setti S. , Manguoglu Ali B.
Published: May 2009

✓ A simple and effective technique is described for the control of bone bleeding during the Cloward procedure for anterior cervical interbody fusion.
Dual cerebral and meningeal supply to giant arteriovenous malformations of the posterior cerebral hemisphere
Authors: Faria Miguel A. , Fleischer Alan S.
Published: May 2009

✓ Seven cases of giant posterior hemisphere arteriovenous malformations are described. The significance of meningeal feeding vessels from the external carotid artery in addition to the primary cerebral supply through the internal carotid and vertebral arteries to these malformations is discussed. The necessity of bilateral selective external carotid arteriography is stressed, and the value of preoperative embolization is questioned.
Microsurgical anatomy of the choroidal arteries: Lateral and third ventricles
Authors: Fujii Kiyotaka , Lenkey Carla , Rhoton Albert L.
Published: May 2009

✓ The microsurgical anatomy of the arteries supplying the choroid plexus of the lateral and third ventricles was examined in 50 formalin-fixed cerebral hemispheres using × 3 to × 20 magnification. There was marked variation in the area of choroid plexus supplied by the choroidal arteries; however, the most common pattern was for the anterior choroidal artery (AChA) to supply a portion of the choroid plexus in the inferior horn and part of the atrium; the lateral posterior choroidal artery (LPChA) to supply a portion of the choroid plexus in the atrium and posterior part of the temporal horn and body; and the medial posterior choroidal artery (MPChA) to supply the choroid plexus in the roof of the third ventricle and a portion of that in the body of the lateral ventricle. The LPChA's and MPChA's occasionally sent branches to the choroid plexus on the contralateral side. The most frequent neural branches of the three choroidal arteries were as follows: AChA branches to the optic tract, cerebral peduncle, temporal lobe, and lateral geniculate body; LPChA branches to the thalamus, geniculate bodies, fornix, and cerebral peduncles; and MPChA branches to the thalamus, pineal body, cerebral peduncle, and tegmentum of the midbrain. Each of the choroidal arteries was divided into a cisternal and plexal segment. The cisternal segments were the most common site of origin of neural branches, but they also gave rise to some plexal branches. The plexal segments occasionally gave rise to neural branches.
Experimental brain injury in the dog
Authors: Clubb Robert J. , Maxwell Robert E. , Chou Shelley N.
Published: May 2009

✓ Brain injury was created in anesthetized dogs by the inflation and subsequent deflation of an epidural balloon. Animals in which intracranial pressure (ICP) increased to 40 torr within 3 hours after balloon removal were included in a randomized treatment protocol that included three treatment groups. Group I (control animals) received no additional treatment. Group II animals received 40 mg/kg pentobarbital initially, plus hourly doses. Group III animals received sufficient sodium nitroprusside to reduce systemic arterial pressure (SAP) to 80 to 90 torr. Pentobarbital reduced ICP compared to control animals, but cerebral perfusion pressure (CPP) was also reduced. Barbiturate treatment also prevented plateau waves. Progressive parallel deterioration in CPP occurred with time in control and pentobarbital-treated animals. The viability of the central nervous system was not improved by pentobarbital. Profound systemic hypotension, a major complication of pentobarbital treatment, required mephentermine to reverse it. Sodium nitroprusside failed to reduce ICP and caused a rapid, profound deterioration in CPP which far exceeded that observed in control or barbiturate-treated animals. Plateau waves were not prevented by nitroprusside. Barbiturates were more potent than nitroprusside in combatting systemic hypertension caused by elevated ICP. Pentobarbital may act by suppression of a central neurogenic mechanism for systemic hypertension and cerebral vasoparalysis. As a cerebral vasodilator, nitroprusside when used in the presence of an intracranial mass, brain edema, or cerebral vasoparalysis, will cause a rise in ICP and a fall in SAP, as well as a drastic reduction in CPP. Its use is probably contraindicated in these situations. Furthermore, it is inferior to barbiturates in reducing ICP and SAP and in preventing plateau waves.
Studies of experimental cervical spinal cord transection
Authors: Tibbs Phillip A. , Young Byron , Todd Edward P. , McAllister R. G. , Hubbard Steve
Published: May 2009

✓ Effects of cervical cord transection on total and regional myocardial blood flow and coronary vascular resistance were studied in anesthetized dogs using 15-µm microspheres. Left atrial catheters were inserted by thoracotomy in 10 dogs and iodine-125-labeled microspheres were injected to measure baseline tissue blood flows by means of the reference flow technique. Four dogs then underwent laminectomy of the C-6 vertebra (control group), and six underwent laminectomy and cord transection (experimental group). Microspheres labeled with cerium-141, strontium-85, and scandium-46 were injected at 15, 30, and 120 minutes, respectively, after surgical intervention. The dogs were sacrificed, and the radioisotope content of specimens of epicardial, mid-myocardial, and endocardial tissues was determined by differential spectrometry, and tissue blood flow was calculated in relation to arterial reference specimens.

No significant differences in baseline endocardial, epicardial, or mid-myocardial blood flow were detected between the control and experimental groups. Tissue blood flows fell significantly in all regions (p < 0.05 or less) at 15, 30, and 120 minutes after transection. No major alteration of the endocardial/epicardial flow ratio occurred, and no electrocardiographic or pathological evidence of ischemia was seen. When corrected for variations in systemic arterial pressure, no differences in coronary vascular resistance between control and cord-transected dogs were observed. These findings suggest that the decreased coronary blood flow following cervical cord transection is secondary to decreased mean arterial pressure rather than to altered coronary vascular resistance. Pharmacological augmentation of perfusion pressure may therefore be necessary to maintain adequate coronary blood flow in patients with acute cord injury who have pre-existent cardiac disease.
Implications of very high serum prolactin levels associated with pituitary tumors
Authors: Shucart William A.
Published: May 2009

✓ Five patients with pituitary tumors associated with unusually high serum prolactin levels are presented. Tumor size and the presence of suprasellar extension were variable, but the finding common to all five cases was invasion of the cavernous sinus. It is proposed that very high serum prolactin levels suggest an invasive tumor, perhaps, specifically, invasion into a cavernous sinus. The surgical significance of this proposition is discussed.
Intracranial lipoma
Authors: Kazner Ekkehard , Stochdorph Otto , Wende Sigurd , Grumme Thomas
Published: May 2009

✓ Eleven cases of intracranial lipoma, diagnosed during life by computerized tomography (CT) scanning, are presented. Clinical symptoms related to the lesions were present in eight. The CT scan establishes the diagnosis of intracranial lipoma on the basis of typical x-ray absorption and location. Only dermoid cysts and teratomas may produce a similar CT appearance. In cases of intracranial lipoma, a direct surgical approach is seldom necessary, although in certain locations, lipomas may cause blockage of cerebrospinal fluid pathways and require a shunt operation.
Intracranial subdural hematoma following lumbar myelography
Authors: Alemohammad Saeid , Bouzarth William F.
Published: May 2009

✓ Persistent headaches after lumbar puncture or myelography can be due to intracranial hematoma. This possibility should be evaluated by computerized tomography, keeping in mind the difficulty in the diagnosis of the isodense subdural hematoma.
Cystic cerebral cavernous angioma with dense calcification
Authors: Ramina Ricardo , Ingunza William , Vonofakos Dimitrios
Published: May 2009

✓ A case of cavernous angioma in the right temporoparieto-occipital area is reported. The unusually large area of calcification and cystic formation presented problems in preoperative diagnosis. The tumor was treated successfully by subtotal excision.
Intermittent appearance of a ruptured cerebral aneurysm on sequential angiograms
Authors: Bohmfalk George L. , Story Jim L.
Published: May 2009

✓ The change in size of a ruptured anterior cerebral artery aneurysm was recorded in a series of angiograms. The aneurysm did not appear on the initial angiogram, but was seen on the second study. Incomplete filling was seen on the third angiogram, and the aneurysm appeared to have thrombosed on the fourth angiogram. On the fifth angiogram, done 5 weeks after the first, the aneurysm filled completely. It was subsequently clipped.
Symptomatic cerebral histoplasmoma
Authors: Schochet Sydney S. , Sarwar Mohammad , Kelly Patrick J. , Masel Brent E.
Published: May 2009

✓ A 53-year-old man, with a past history of a thoracotomy 7 years previously, developed seizures. A computerized tomography scan with contrast medium revealed a peripheral ring-like lesion in the anterolateral part of the right parietal lobe. Pathological evaluation of the resected lesion demonstrated it to be a histoplasmoma. Although rare, a histoplasmoma should be included in the differential diagnosis of a ring-shaped lesion in a patient with previous pulmonary disease.
A clinicopathological study of patients following a subarachnoid hemorrhage
Authors: Doshi Rasikbala , Neil-Dwyer Glen
Published: May 2009

✓ The hypothalamus and myocardium of 54 patients (27 males and 27 females, age range 12 to 73 years) who died after subarachnoid hemorrhage (SAH) were examined historically. In 42 patients, hypothalamic and myocardial lesions were found; in seven, hypothalamic lesions only; and in five, no hypothalamic nor myocardial lesions. A similar examination was performed on a control group of 25 patients (12 males and 13 females, age range 17 to 70 years) who had died from a variety of causes, all producing raised intracranial pressure. In these, no lesions were found in either the hypothalamus or the myocardium. The age of the patient, the site of the vascular pathology, and whether an operation was performed appeared to have no effect on the occurrence of hypothalamic and heart lesions; however, there was a correlation between these lesions, progressive neurological deterioration, and varying pulse rates and blood pressures. This study produces further evidence of the involvement of the autonomic nervous system in some of the deleterious effects of SAH, and a suggestion is made as to possible treatment.
Pain reduction in amputees by long-term spinal cord stimulation
Authors: Krainick Jörg-Ulrich , Thoden Uwe , Riechert Traugott
Published: May 2009

✓ This follow-up study analyzes the results of dorsal column stimulation instituted between 1972 and 1974 for the relief of pain in 84 patients, including 64 amputees. Good results decreased from 52.4% after 2 years of stimulation to 39% after 5 years. Special therapeutic problems in amputees are discussed.
The effect of phenobarbital on the toxicity and tumoricidal activity of CCNU in a murine brain tumor model
Authors: Muller Paul J. , Tator Charles H. , Bloom Martin
Published: May 2009

✓ The nitrosoureas are known to be substrates for hepatic microsomal enzymes. Since phenobarbital (PB) is a potent inducer of hepatic microsomal enzymes, and since PB and other enzyme-inducing drugs are commonly used in patients with brain tumors, the authors have assessed the effect of PB pretreatment on the toxic and tumoricidal activity of CCNU in a murine model.

In C57B1/6J mice, PB pretreatment markedly reduced the lethal toxicity of high doses of CCNU. The LD99 dose of CCNU was found to be 80 mg/kg given intraperitoneally. Pretreatment with PB reduced the toxic death rate of CCNU at 40, 60, 90, or 120 mg/kg to less than 10% (p < 0.01). Pretreatment with PB also reduced the tumoricidal activity of CCNU. In an intracerebral murine ependymoblastoma, intraperitoneal CCNU alone, at 30 mg/kg given on the 5th day after tumor transplantation, produced a percent increased life span (%ILS) of > 300, and 18 of 25 were long-term survivors (LTS). In contrast, after four daily doses of PB prior to the same dose of CCNU, the %ILS was reduced to 85 with no LTS among 25 mice (p < 0.01). When CCNU was given alone at 30 mg/kg intraperitoneally on Day 10, a %ILS of > 300 with 22 of 25 LTS resulted; whereas, PB pretreatment reduced the %ILS to 15, with two of 25 LTS (p < 0.01). When CCNU was administered directly into the tumors intracerebrally at 30 mg/kg on Day 10, the %ILS was > 300, with 16 of 20 LTS; whereas, PB pretreatment reduced the %ILS to 50 with five of 20 LTS (p < 0.01). Furthermore, PB pretreatment significantly reduced the ability of CCNU to retard tumor growth in a subcutaneous murine ependymoblastoma.

Thus, PB pretreatment significantly altered the activity of CCNU. Since enzyme-inducing drugs are so commonly used in patients with brain tumors, it is possible that the clinical failure of nitrosoureas in some cases may be due to an unsuspected drug antagonism.
Idiopathic normal-pressure hydrocephalus
Authors: Black Peter McL.
Published: May 2009

✓ Of 62 patients given shunts for normal-pressure hydrocephalus of idiopathic type, 46.8% showed some improvement and 27.4% enjoyed virtually complete recovery. The best clinical predictor of good response was the complete triad of memory difficulty, gait disorder, and urine incontinence; 61.2% of patients with this combination of symptoms improved. Gait disturbance alone was also accompanied by improvement in two of three patients. An “obstructive” cisternographic radioisotope pattern was not significantly different from a “normal” pattern in predicting a response to shunting. Computerized tomography (CT) showing large ventricles and little atrophy predicted improvement in 11 out of 13 patients. There were five deaths within 3 months of shunting. The complication rate was 35.4%; subdural collections, shunt malfunction, and postoperative seizures constituted the most frequent complications.

These data suggest that continued investigation for better predictions of shunt response is important, but that in the meantime the clinical pattern and cranial CT pattern are the most satisfactory guides to improvement after shunting.
Indications for angiography in the preoperative evaluation of patients with prolactin-secreting pituitary adenomas
Authors: Richmond Isabelle L. , Newton Thomas H. , Wilson Charles B.
Published: May 2009

✓ The preoperative angiograms of 100 patients subsequently undergoing transsphenoidal exploration for prolactin-secreting pituitary adenomas were reviewed in order to assess both the risk of this study and its yield of useful diagnostic information. In these patients with documented hyperprolactinemia, no vascular anomalies contraindicating a transsphenoidal approach were detected. Tumor blush was evident only in large tumors. The appearance of lateral displacement of the carotid siphon in basilar views was not a reliable predictor of lateral extension. When hyperprolactinemia can be documented, the authors' current practice is to reserve angiography for patients who have gross sellar expansion or suprasellar extension, or for those who have had prior radiotherapy.
Knotted ventriculoatrial catheter
Authors: Dean David F.
Published: May 2009

✓ In this patient a No. 5 French infant feeding tube was advanced through the right basilic vein into the superior vena cava, and became knotted around the end of an atrial catheter placed in the left common facial vein. The atrial catheter stretched sufficiently to allow excision of the knot as it came through the antecubital incision. It then snapped back up into the axillary vein. A shuntgram with 60% Renograffin demonstrated the position of the ventriculoatrial catheter in the axillary vein. Subsequently, the catheter slid back into the atrial position.
Acute spinal cord compression by subarachnoid and subdural hematoma occurring in association with brachial plexus avulsion
Authors: Russell Neville A. , Mangan Michael A.
Published: May 2009

✓ The authors report a case of acute spinal còrd compression caused by a subarachnoid and subdural hematoma. This occurred following traumatic brachial plexus avulsion. It is believed to be the first such case recorded.
Cerebellar astrocytoma invading the musculature and soft tissues of the neck
Authors: Kepes John J. , Lewis Revis C. , Vergara Gerardo G.
Published: May 2009

✓ A case of cerebellar astrocytoma with unusual growth pattern in an 8-year-old boy is reported. The tumor had some histological hallmarks of malignancy (focally high cellularity, mitotic figures, necroses, and calcifications) and, 17 months after subtotal removal, recurred as a nuchal mass in the area of the incision, infiltrating first the skeletal musculature and later other soft tissues of the neck, including lymph nodes. Although cerebellar astrocytomas may recur locally and some may even seed through the cerebrospinal fluid, this is the first reported case of a tumor of this group to infiltrate skeletal muscle and other soft tissues of the neck. The patient underwent five operations to relieve the cervical organs from pressure.
Tuberculous brain abscess
Authors: González P. R. Mata , Herrero Carlos Vázquez , Joachim G. Flambert , Ocaña C. Ruiz , Sevilla G. Cobo , Loyzaga P. Gil
Published: May 2009

✓ An abscess was removed from the left occipital region in a 73-year-old woman with no previous history of tuberculosis. The patient later died from aspiration bronchopneumonia. Autopsy revealed a basilar tuberculous meningitis and miliary tuberculosis in the peritracheal lymphatic glands, the liver, the spleen, and in isolated areas of the lungs. No chronic tuberculous foci were noted in any area. Including this case, only 18 instances of tuberculous abscess have been reported.
Cortical cellular response in acute subarachnoid hemorrhage
Authors: Hubschmann Otakar R. , Kornhauser David
Published: May 2009

✓ Acute subarachnoid hemorrhage (SAH) over the cerebral cortex causes single or multiple waves of cellular depolarization, which may occur in a self-propagating, reverberating fashion. This process is characterized by a massive K+ release and transient depression in electrocortical activity. The K+ levels in the extracellular space reach magnitudes known to substantially affect the membrane potentials of neurons and glia, and may cause a release of neurotransmitters from depolarized presynaptic terminals. The release of K+ may be the initial step in the development of cellular edema and, together with a multitude of other chemical and biochemical changes taking place at the cellular level, may underlie the loss of autoregulation. Cortical cells rather than blood vessels are the primary targets in the initial stages of SAH, and ischemia does not play a causal role in the pathogenesis of cellular dysfunction during this stage.
Spinal neurological complications of achondroplasia
Authors: Morgan David F. , Young Ronald F.
Published: May 2009

✓ Spinal neurological complications caused the admission of 17 patients with achondroplasia to the UCLA affiliated hospitals between 1955 and 1979. These patients constituted 41% of all achondroplastic patients admitted during that period. The spinal stenotic syndromes could be divided into three groups: Group I: thoracolumbar stenosis (10 patients); Group II: foramen magnum and upper cervical stenosis (five patients); and Group III: generalized spinal stenosis (two patients). Eleven patients underwent a total of 18 decompressive operative procedures for treatment of paraparesis, quadriparesis, sensory deficits, and sphincter dysfunction. Excellent results were obtained with patients in Group I and II, 77% of whom were ambulatory and continent postoperatively. Two patients in Group III fared less well, showing steady neurological deterioration despite multiple operative procedures.

The spectrum of spinal neurological manifestations secondary to achondroplasia is reviewed. Problems with conventional radiological studies and the potential role of computerized tomographic analysis of such patients are discussed. Recommendations for surgical technique are made. Early recognition, prompt clinical evaluation, and safe and accurate radiological analysis of spinal neurological complications of achondroplasia will allow appropriate decompressive surgical procedures to be performed. Excellent results may be anticipated in the reversal and prevention of neurological deficit secondary to achondroplasia with such an approach.
Retrospective analysis of 22 patients with chronic pain treated by peripheral nerve stimulation
Authors: Law Jay D. , Swett John , Kirsch Wolff M.
Published: May 2009

✓ Twenty-two patients with chronic pain, chiefly from posttraumatic neuropathy, were treated by implanted peripheral nerve stimulators located proximal to the pain. Thirteen of these (62%) have experienced pain control for an average of 25 months. The experience of the surgeon is thought to be a major factor contributing to the successful results. There are theoretical and practical advantages to electrical stimulation at proximal portions of the peripheral nervous system. The surgical technique for implantation is described, and the necessity for reoperation in some patients is explained.
Diphtheroid infections of cerebrospinal fluid shunts
Authors: Rekate Harold L. , Ruch Teresa , Nulsen Frank E.
Published: May 2009

✓ In the process of trying to decrease infection rates, gentamicin has been used to irrigate shunt systems at the time of surgery. The infection rate did not change, but the epidemiology of infecting organisms changed from Staphylococcus epidermidis to diphtheroids. These indolent and sometimes asymptomatic infections can progress to cause systemic disease with nephritis, peritonitis, or blocked shunts, and are difficult to detect. Laboratory values of cerebrospinal fluid and blood may not be helpful, but prolonged culture incubation on anaerobic media will subsequently yield the organism. Systemic and intraventricular antibiotics may rid the system of diphtheroids and avoid morbidity of shunt revision if the infection is found before systemic disease occurs.
Histological features of congenital lipomas of the lower spinal canal
Authors: Walsh John W. , Markesbery William R.
Published: May 2009

✓ A study of 20 children with lipomyelomeningocele and two with intradural lipoma who underwent surgery revealed that five children had unusual and previously unreported histological findings. In each, the characteristic densely fibrous lipoma was present. One patient with an intradural lipoma had an ependymallined canal resembling a terminal ventricle. The subependymal layer was neuroglial and striated muscle fibers were scattered throughout adjacent connective tissue and lipoma. Three other children presented with lipomyelomeningoceles. In each case, the lipoma tapered to a firm fibrous tract which blended into conus medullaris. Microscopic examination of this fibrous tract showed it to contain not only a relatively acellular connective tissue stroma, but, in one case, sheets or islands of neuroglia and scattered nerve cells, in another, an epithelial cyst with a smooth muscle and fibrous tissue wall, and in a third case, a fragment of embryonic bone. These findings support the theory that there is a secondary phase to caudal neural tube development, and that congenital lipomas are formed by persistence and differentiation of ordinarily vestigial pluripotential embryonic cells. The fifth case, with extradural lipoma, diastematomyelia, and congenital dermal sinus, had a cyst at the junction of these structures. The cyst was lined by ciliated respiratory-like epithelium, and had mucous and serous glands in its wall. This finding supports the concept that formation of diastematomyelia depends on the prior existence of an accessory neurenteric canal.
Spontaneous recurrent hemorrhage as an unusual complication of fibrous dysplasia of the skull
Authors: Graf Carl J. , Perret George E.
Published: May 2009

✓ The case of a patient with fibrous dysplasia of the skull associated with recurrent spontaneous hemorrhage is presented. Suggestions for management of this unusual complication are made.
Cerebral convexity epidermoid tumor subsequent to multiple percutaneous subdural aspirations
Authors: Gutin Philip H. , Boehm Jennie , Bank William O. , Edwards Michael S. , Rosegay Harold
Published: May 2009

✓ While occasional spinal epidermoid tumors may arise subsequent to lumbar punctures, the association of cerebral epidermoid tumors with percutaneous subdural taps has not been made. The case is reported of a 30-year-old man with a right frontal convexity epidermoid tumor beneath the coronal suture, through which, as an infant, he had had multiple percutaneous subdural taps.
Giant cell granuloma involving the pituitary gland
Authors: Taylon Charles , Duff Thomas A.
Published: May 2009

✓ The case is reported of a middle-aged man who had developed relatively acute, unilateral ophthalmoplegia. Radiological studies indicated a mass lesion involving the pituitary gland and right cavernous sinus. Pituitary tissue obtained by transsphenoidal hypophysectomy contained giant cell granuloma. In previous cases, the documentation of giant cell granuloma of the pituitary gland has been limited to autopsy tissue.
A new catheter for detection and treatment of venous air embolism
Authors: Hicks Henry C. , Hummel James C.
Published: May 2009

✓ The authors report the successful application of the No. 8 French multi-orifice flow-directed catheter designed for pulmonary angiography in the monitoring and treatment of venous air embolism during neurosurgical procedures. Delays in operating room time were reduced with this technique, which ensures rapid and precise placement of a right atrial central line and which also eliminates the need for a chest film as a method of confirming placement of the central line in the right atrium. The flow-directed guidance system permits reliable introduction of the catheter via any central venous access route, including the basilic vein, and eliminates the usual difficulties associated with placement of conventional single-orifice polyethylene catheters. No complications associated with placement of this catheter into the right atrium have occurred in 20 cannulations.
Drill stop for twist drill
Authors: Grode Marshall L. , Carton Charles A.
Published: May 2009

✓ An inexpensive, readily available drill stop is described that can be applied to the twist drill bit to reduce the risk of “plunge.”
Neurological course and correlated computerized tomography findings after severe closed head injury
Authors: Clifton Guy L. , Grossman Robert G. , Makela Merry E. , Miner Michael E. , Handel Stanley , Sadhu Vijay
Published: May 2009

✓ This study includes 124 patients with closed head injuries and with Glasgow Coma Scale (GCS) scores of ≤ 8, who were admitted over a 7 1/2-month period. The time at which death occurred after injury was bimodal: deaths occurred either within 48 hours or after 7 days or longer after injury. Neurological deterioration, however, occurred with equal frequency on Days 2 to 7 after injury. Patients who survived the first 48 hours and then suffered neurological deterioration did not differ from the total population in age, sex, GCS scores on admission, or pupillary reactivity, but had a much higher incidence of intracranial hematomas of all types. Deterioration occurred three times more frequently in those with hematomas than in those with diffuse brain injury. Patients who deteriorated were rarely among the 35% of those who rapidly improved in the first 48 hours (4 points or more on the GCS). Computerized tomography (CT) scans of those deteriorating (24 patients) could be divided into four categories: 1) those without new mass effect (eight cases); 2) those with new or increased hemispheric edema (six cases); 3) those with generalized edema (two cases); and 4) those with focal or lobar areas of new edema or hemorrhage (eight cases). Of the patients in coma who deteriorated, 19% had large, delayed intracerebral hematomas. In 11 of 16 cases deteriorating with new mass effect, prior compression by overlying extracerebral hematoma, disruption of brain by intra-cerebral hematoma, or preexisting hemispheric edema preceded the brain swelling that caused deterioration. Areas of disruption or compression on CT scan typically developed decreased attenuation 2 to 7 days after injury, but did not cause deterioration unless new mass effect accompanied the lucency appearing on CT scan. A mortality rate of 29% was achieved for the 124 cases, which were managed with early evacuation of hematomas and control of intracranial pressure. Certain methods are suggested for evaluating therapy and for comparing clinical series.
Prolonged posttraumatic unconsciousness
Authors: Bricolo Albino , Turazzi Sergio , Feriotti Giannantonio
Published: May 2009

✓ Prolonged coma following severe head injury is a serious condition because it implies a poor prognosis. In order to assess the magnitude of this phenomenon, the authors have reviewed 135 cases of posttraumatic unconsciousness lasting more than 2 weeks, from among the entire propulation of patients with severe head injury managed in 10 years in their neurosurgical intensive care unit. The incidence of prolonged coma was 4% of all patients with acute traumatic coma, and 0.6% of all hospitalized patients with head injury. By 1 year after trauma, 30% of the patients had died, 8% survived in a vegetative state, 31% survived with severe disabilities, and 31% had made a satisfactory recovery. The early clinical picture of prolonged unconsciousness has no predictive value as to further evolution. Patients emerge from unconsciousness in consecutive steps representing the restoration of increasingly complex neurological functions; the timing of these steps is very variable and sometimes covers several months. The time distribution of recovery steps in individual cases is of limited predictive value as to outcome. The most frequent state during the recovery process is the condition of wakefulness without awareness, which should not be pronounced “permanent” earlier than 1 year after injury.
Homovanillic acid and 5-hydroxyindoleacetic acid in the ventricular CSF of comatose patients with obstructive hydrocephalus
Authors: Inagawa Tetsuji , Ishikawa Susumu , Uozumi Tohru
Published: May 2009

✓ Ventricular cerebrospinal fluid (CSF) levels of homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA) were determined every 2 to 4 hours over a period of 1 to 4 days in 12 patients, consisting of seven cases of brain tumor, two cases of cerebrovascular disease, and three cases of head injury. The concentrations of HVA and 5-HIAA varied with time in all cases, and significant correlations were found between the two values in eight cases. However, the relationship between variations of HVA and 5-HIAA levels and rhythms of sleep and waking could not be clarified. Both HVA and 5-HIAA concentrations varied at high levels in two patients whose CSF flow was completely blocked by tumor at the site of the fourth ventricle and aqueduct, respectively. On the contrary, in a case with craniopharyngioma in the third ventricle which blocked the bilateral foramina of Monro, although the HVA values were high, the 5-HIAA values varied at low levels. Of five comatose patients, two had cerebrovascular lesions and three had sustained head injury, and, in four of the five, the values of either one or both of HVA and 5-HIAA were low, but in the fifth case the 5-HIAA value was high.

Estimation of HVA and 5-HIAA concentrations in ventricular CSF may be a valuable tool in the investigation of brain monoamine metabolism. However, many factors must be considered in the interpretation of results of clinical studies.
Prognostic significance of the pretreatment CT scan on time to progression for patients with malignant gliomas
Authors: Levin Victor A. , Hoffman William F. , Heilbron David C. , Norman David
Published: May 2009

✓ Case histories of 61 patients receiving multimodality therapy for primary malignant brain tumors were reviewed for factors visible on the computerized tomography (CT) scan that correlated with the interval of time from diagnosis and pretherapy evaluation to the time of documented tumor progression. The initial pretreatment CT scan of each patient was reviewed. Midline shift, peritumor low density (edema), the greatest diameter of tumor enhancement, and the greatest diameter of the intratumor low-density area were measured prior to radiation therapy and chemotherapy. Using a Weibull survival probability model, time to tumor progression was most satisfactorily fitted using two covariates, the volume of enhancing tumor (for instance, contrast-enhancing tumor less intratumor low density), and the presence of a peritumor low-density area. Patients who exhibited a small amount of contrast-enhancing tumor with peritumor low density tended to have a longer time to progression than patients with large contrast-enhancing tumor volume and no peritumor low density. Midline shift was not as important a variable as the extent of tumor contrast enhancement or peritumor low density.
Use of cerebral evoked potentials to evaluate spinal somatosensory function in patients with traumatic and surgical myelopathies
Authors: Dorfman Leslie J. , Perkash Inder , Bosley Thomas M. , Cummins Kenneth L.
Published: May 2009

✓ Cerebral somatosensory evoked potentials (SEP's) were elicited by electrical stimulation of the median nerve in the arm (SEPA) and of the posterior tibial nerve in the leg (SEPL) in 23 patients with incomplete localized lesions (including traumatic injuries, neoplasms, vascular malformations and infarcts) of the low cervical, thoracic, or lumbar spinal cord. In eight of 46 attempts (left and right sides), SEPL could not be recorded. Of the remaining 38 sides, spinal somatosensory conduction velocity (SSCV, indirectly estimated) was abnormally slow (< 35 m/sec) in 20, and the amplitude of SEPL relative to SEPA (L:A ratio) was abnormally low (< 0.5) in 20 (p < 0.001 in each case, compared to normal controls). All three criteria yielded a combined 72% incidence of abnormality, correlating best with impairment of joint position sense. Serial postoperative studies in four cases documented an increase in the SSCV and L:A ratio following spinal decompression. These results demonstrate that the latency and amplitude characteristics of the cerebral SEP's from arm and leg permit quantitative evaluation of the functional status of the spinal somatosensory system.
Transsphenoidal microsurgery in the management of craniopharyngioma
Authors: Laws Edward R.
Published: May 2009

✓ The rationale for the transsphenoidal approach in the surgical management of craniopharyngioma is presented, based on experience with 26 cases. In 14 patients without prior therapy, nine had “total” removal of the lesion, and only two had permanent postoperative diabetes insipidus. One operative death occurred in this group, and two patients had cerebrospinal fluid leaks. In 12 patients who had undergone prior craniotomy, successful palliation was accomplished, at least temporarily, in every case. Vision was improved postoperatively in 15 of the 16 patients who presented with visual loss. Enlargement of the sella by the tumor is the critical feature allowing for successful transsphenoidal management.
Topical organization of the distal portion of the facial nerve
Authors: Kempe Ludwig G.
Published: May 2009

✓ Intraoperative stimulation of the distal section of the facial nerve was performed in 29 patients undergoing surgery for glomus jugulare tumor. A definite and persistent topical anatomical arrangement was observed.