bluuebunny/crossref_metadata_2025 huggingface dataset:
Occult Esophageal Perforation Associated with Cervical Spine Fracture
Authors: Tomaszek David E. , Rosner Michael J.
Published: August 2004

A case of surgically confirmed cervical esophageal perforation associated with burst fractures of two cervical vertebral bodies is presented. We also describe a second case in which an incidentally discovered abscess of the cervical region could have been the result of esophageal perforation secondary to spine injury. Both patients had negative positive contrast esophagograms. This complication of cervical spine injury is extremely rare, and diagnosis can be difficult. Cervical esophageal perforation must be considered in the face of unexplained cervical, thoracic, or systemic sepsis and in the presence of an unexplained cervical mass. Severe cervical fracture with or without subluxation seems to constitute the anatomical basis for the entity. The treatment consists of drainage and antibiotics aimed at oral flora. The clinical features, diagnostic tests, and surgical management of this entity are reviewed.
Case Report: Polysomnographic Effects of Thalamotomy for Torsion Dystonia
Authors: Jankel William R. , Niedermeyer Ernst , Graf Martin , Kalsher Michael J.
Published: August 2004

We report a patient with torsion dystonia whose polysomnographic recordings revealed poor sleep and a pronounced and almost continuous type of spindle activity during non-rapid eye movement sleep. Rapid eye movement sleep was also reduced. These changes proved to be independent of medications. After a clinically successful unilateral thalamic operation, a normalization of sleep parameters and a reduction of the high amplitude sleep spindles was observed. implying that the regulation of sleep spindles and the advancement of dystonic symptoms are affected by a common mechanism.
Pain Relief after Hypophysectomy
Authors: Ramirez Lincoln F. , Levin Allan B.
Published: August 2004

Thirteen series of patients who underwent surgical or chemical hypophysectomy for the relief of pain associated with cancer were reviewed. In 10 series, involving 334 patients with breast or prostate cancer, surgical hypophysectomy produced pain relief in 70% of the patients afflicted with either tumor, including some with no evidence of hormone dependence. These results were then compared with the results of chemical hypophysectomy. This procedure was performed in 3 series involving 533 patients, of whom 24% had cancer other than breast or prostate. Chemical hypophysectomy produced pain relief in over 75% of the patients, regardless of tumor type or hormonal dependence. The possible role of the pituitary, the hypothalamus, and endogenous opiates in mediating the pain relief associated with hypophysectomy was examined. The mechanism by which pain relief is achieved remains unclear, but there is significant evidence that this relief is not related directly to the expected fall in the levels of known pituitary hormones. Evidence is provided that pain relief is the result of a hypothalamic pain-suppressing capability triggered by hypophy-sectomy. On the basis of both clinical data and the mechanism of action, we conclude that surgical and chemical hypophysectomy are fundamentally similar procedures.
Results of Extracranial-Intracranial Arterial Bypass for Intracranial Internal Carotid Artery Stenosis: Review of 105 Cases
Authors: Weinstein R.Philip , Rodriguez y Baena R. , Chater L.Norman
Published: August 2004

Extracranial-intracranial arterial bypass was performed for intracranial internal carotid artery stenosis in 105 patients who had ischemic symptoms 1 to 3 months before operation. The degree of stenosis, measured angiographically, was 60 to 98%. The postoperative bypass patency rate, determined angiographically or by Doppler examination, was 97%. The surgical mortality rate was 1%, and the permanent surgical morbidity rate was 2%. During a mean follow-up period of 54 months, 22 patients died: 10 deaths were caused by cardiac disease and 3 were related to stroke, 2 of which were ipsilateral to the bypass. One patient was lost to follow-up. Seventy-three of the 82 survivors (89%) had no further transient ischemic attacks or stroke after operation. Seven patients had a late stroke: 5 were ipsilateral, 1 was contralateral, and 1 was vertebrobasilar. Three of these strokes were fatal. The overall late death rate was 4% per year, and the late death rate from neurological causes was 0.6% per year. The late stroke rate was 1.5% per year, and the rate of ipsilateral late stroke in patients who had a patent bypass was 0.6% per year. We conclude that extracranial-intracranial arterial bypass for symptomatic intracranial internal carotid artery stenosis is a reasonably safe and technically satisfactory procedure that has a potential for improving outcome, compared with the natural history of the disease.
Brain Tumors and Plasmin Inhibitors
Authors: Sawaya Raymond , Cummins J.C. , Kornblith L.P.
Published: August 2004

Four different intracranial neoplasms inhibited purified plasmin in an in vitro assay. The greatest inhibition (80%) was observed with extracts of a parasagittal meningioma that had invaded and completely occluded the sinus. Significant inhibition (>40%) was also observed with extracts prepared from a glioma surgically removed from a patient who had suffered three thromboembolic episodes during the preceding several months. Lesser (<30%) inhibition was obtained with extracts from two other patients who had no evidence of thromboembolic complications. This report constitutes the first demonstration of plasmin inhibition activity in association with brain tumors. Further studies will be required to test the hypothesis that certain intracranial tumors may escape host antitumor fibrinolytic activity by producing plasmin inhibitors and that plasmin inhibitors may play a role in the thromboembolic complications frequently seen in patients with intracranial neoplasms.
Use of Intraventricular and Intrathecal Morphine in Intractable Pain Associated with Cancer
Authors: Nurchi Giancarlo
Published: August 2004

The use of the intraventricular or subarachnoid administration of morphine in the treatment of intractable pain secondary to cancer is described. The drug, in doses ranging from 0.33 to 4.00 mg, was administered by the percutaneous injection of an Ommaya reservoir or by a spinal tap. The duration of analgesia ranged from 36 to 150 hours. The indications for and side effects of this type of therapy are considered.
Percutaneous Radiofrequency Upper Thoracic Sympathectomy: A New Technique
Authors: Wilkinson Harold A.
Published: August 2004

The author describes a new technique for performing unilateral or bilateral upper thoracic sympathectomy safely, effectively, and more easily than by any of the surgical methods now in use. The technique described is one of percutaneous radiofrequency sympathectomy, which is usually done on a day surgery or outpatient surgery basis. The technique has been effective and well tolerated in a small group of patients.
Abnormal Serum Melatonin Levels in Patients with Intrasellar Tumors
Authors: Dempsey Robert J. , Chandler William F.
Published: August 2004

Melatonin, a pineal indoleamine, is postulated to be of importance in a regulatory fashion in hypothalamic and pituitary function. Attempts to utilize its random serum level as a consistent marker of pineal tumors have not been successful. Fifteen patients were studied to determine whether the normal diurnal variation in serum melatonin as determined by radioimmunoassay was altered by the presence of an intrasellar pituitary region tumor. A normal diurnal cycling of melatonin (high level at night, low level at midday coupled to the light-dark cycle) was seen in controls consisting of patients admitted for spinal or supratentorial procedures (a.m. melatonin, 15.4,± 3.7 pg/ml; p.m. melatonin, 57.1 ± 16.3 pg/ml). This normal pattern of melatonin levels was altered in the group of patients with intrasellar tumors (a.m. melatonin, 28.9 ± 6.7 pg/ml; p.m. melatonin, 28.4 ± 7.3 pg/ml). Hospitalization and operation caused nonspecific alterations in the pattern of melatonin in both groups. These results suggest that the pattern of secretion rather than the absolute midday value of melatonin may be of greater importance as evidence of altered pineal and pituitary neuroendocrine regulation.
Spinal Metastatic Disease: Analysis of Factors Determining Functional Prognosis and the Choice of Treatment
Authors: Barcena Alejandro , Lobato Ramiro.D , Rivas Juan , Cordobes Francisco , de Castro Servando , Cabrera Antonio , Lamas Eduardo
Published: August 2004

The authors surveyed 31 surgical and radiotherapy series comprising over 2300 patients with spinal metastases to determine the influence of factors such as tumor biology and topography, pretreatment neurological status, the presence of a myelographic block, the progression rate of symptoms, and the general medical condition of the patient on both the functional prognosis and the choice of treatment. Both life expectancy and the functional results after therapy are mainly dependent on tumor biology, which in turn determines radiosensitivity. The remaining factors seem to have only complementary predictive power. Because radiotherapy has been found to be as effective as operation plus radiotherapy in the management of the majority of patients with spinal metastases, it is very important to improve the selection of surgical candidates (less than 42% of the total cases) to prevent unnecessary surgery-related morbidity and mortality. Factors considered important in the selection of therapy are the location of the tumor within the spinal canal, the neurological status at the time of treatment, and the systemic condition of the patient.
Therapeutic Occlusion of the Vertebral Artery for Unclippable Vertebral Aneurysm: Relationship between Site of Occlusion and Clinical Outcome
Authors: Yamada Kazuo , Hayakawa Toru , Ushio Yukitaka , Yukitaka Yoshikazu , Koshino Kentaro , Bitoh Shoji , Takimoto Noboru
Published: August 2004

Six cases of unclippable vertebral aneurysms were treated by therapeutic occlusion of the proximal vertebral artery. In three cases, the vertebral artery was clipped proximal to the posterior inferior cerebellar artery (PICA), and all of these patients had a postoperative embolic complication or a fatal subarachnoid hemorrhage. In two cases, the vertebral artery was clipped distal to the PICA and in one case the PICA was absent and the vertebral artery was clipped proximal to the aneurysm. All three of these patients did well without any neurological deficit, Possible mechanisms of the complications are discussed, and the importance of not clipping the PICA is stressed.
Peripheral Aneurysms of the Posterior Inferior Cerebellar Artery
Authors: Yamamoto Isao , Tsugane Ryuichi , Ohya Masaki , Sato Osamu , Ogura Koichiro , Hara Makota
Published: August 2004

Nonmycotic peripheral posterior inferior cerebellar artery (PICA) aneurysms are rare. The authors report six cases of peripheral PICA aneurysm. Two of these are unusual; one was fusiform and another was a double aneurysm arising from the peripheral PICA. The previously reported 40 cases of peripheral PICA aneurysm are reviewed.
Acute Hydrocephalus in an Elderly Woman with an Aneurysm of the Vein of Galen
Authors: Rosenfeld Jeffrey V. , Fabinyi Gavin C. A.
Published: August 2004

A patient with a previously diagnosed vein of Galen aneurysm presented with acute hydrocephalus. This unusual case is described, and the possible pathogenesis of the condition is discussed. To our knowledge, this is the oldest patient yet described with this complication of vein of Galen aneurysm.
Cerebral Vasospasm after Head Injury
Authors: Pasqualin Alberto , Vivenza Carlo , Rosta Luisa , Licata Claudio , Cavazzani Paolo , Da Pian Renato
Published: August 2004

Cerebral vasospasm occurs frequently after head injury. Correlation between neurological deterioration and vasospasm has been reported previously, but delayed neurological deterioration secondary to vasospasm in head injury is a rare occurrence. We report the case of a 57-year-old man who, after a motorcycle accident, developed an acute subdural hematoma and a thick subarachnoid deposition of blood in the left sylvian-insular cistern. After surgical evacuation of the hematoma, the patient improved until the 10th postoperative day, when he developed aphasia and a right hempiparesis. Angiography demonstrated multitapering spasm, and a computed tomographic (CT) scan showed persistence of the cisternal deposition of blood. Despite therapy with hypervolemia, the patient improved only slightly. The association of head injury with substantial subarachnoid hemorrhage producing vasospasm has been considered rarely. Delayed posttraumatic vasospasm secondary to blood degradation products seems to play some role in the vasospasm after head injury. CT scanning may be useful in predicting vasospasm in such patients, and digital subtraction angiography might be useful in demonstrating it.
Planum Sphenoidale Meningioma Mimicking Pituitary Apoplexy: A Case Report
Authors: Marano Stephen R. , Sonntag Volker K.H. , Robert F. Spetzler
Published: August 2004

A patient with a planum sphenoidale meningioma mimicking a classic case of pituitary apoplexy is presented. A review of the apoplectiform onset of meningiomas is included.
Multiple Intradural Arachnoid Diverticuli: The Need for Complete Myelography
Authors: Schroeder Kurt A. , Venes Joan L.
Published: August 2004

A 12-year-old boy presented with enuresis, leg weakness, and lower extremity spasticity. An initial lumbar water-soluble contrast myelogram disclosed an arachnoid diverticulum. After the insertion of a cystopleural shunt, the patient improved and was dry. However, 2 months later the patient became enuretic and developed weakness. Repeat myelography showed a second arachnoid diverticulum located in the midthoracic region. This second diverticulum was treated by marsupialization of the cyst wall to the subfascial space. The authors stress the need for complete myelography in patients with intradural spinal arachnoid diverticuli and present a brief review of the literature.
Gliosarcoma at the Site of a Surgically Treated Actinomyces Cerebral Abscess
Authors: Prager Jordan , Zaret Bruce S. , Davidson Robin , Smith Thomas W.
Published: August 2004

We describe a man who developed a gliosarcoma at the site of a previously surgically decompressed frontal Actinomyces israelii brain abscess. We review the clinical profile of gliosarcoma and the possible role of the abscess and operation in the induction of this malignancy.
Intradural Spinal Metastasis in Ewing's Sarcoma: Case Report and Review of the Literature
Authors: Wald Steven L. , Roland Thomas A.
Published: August 2004

Ewing's sarcoma is a rare primary osseous neoplasm of children and young adults. The use of radiotherapy and adjuvant chemotherapy has favorably influenced the outcome of patients and dramatically reduced the rate of local disease recurrence. However, distant metastasis, usually to the lung and skeletal system, continues to be a frequent preterminal event. Metastasis to the central nervous system is infrequent unless related to adjacent bone involvement. We report a case of intraneural, intradural metastasis in a young man with a previously treated Ewing's sarcoma of the ilium. Metastasis to this part of the nervous system has not been previously reported.
Cervicomedullary Junction Tumor Diagnosed by Nuclear Magnetic Resonance Scanning: Case Report
Authors: Kaufman Bruce A. , Kaufman Benjamin , Rekate Harold L.
Published: August 2004

A neurofibroma of the cervical medullary region was accurately delineated using nuclear magnetic resonance (NMR) scanning. The tumor and its compression of the spinal cord were so well visualized that evaluation by myelography and postmyelographic computed tomography (CT) was unnecessary. NMR scanning should be considered as a replacement for myelography with CT in the initial evaluation of cervicomedullary spinal cord tumors.
Superficial Dorsal Horn of the Adult Human Spinal Cord
Authors: Bowsher David , Abdel-Maguid Thoraya .E
Published: August 2004

Golgi studies in the adult human spinal cord reveal 10 cell types in the first three laminae. Five are Golgi Type II or ipsilateral proprioneurons of short or long range-the latter including Waldeyer cells. Several of the cells in this group have dendrites that help to form interlaminar boundaries on the gray-white boundary. Two of the four cell types in Lamina II have dendritic fields that correspond exactly to the primary afferent terminal axonal fields described in the cat by Rethelyi (1977). Three cell types, one in each lamina, can be tentatively homologized with monkey spinothalamic cells described by other authors. Our previously described classification method based on dendritic patterns suggests that the Golgi Type II interneurons and ipsilateral proprioneurons belong to two different cell families (and Waldeyer cells to a third), whereas the putative spinothalamic neurons are all different cell types.
Neuropharmacology of the Dorsal Root Entry Zone
Authors: Blumenkopf Major Bennett
Published: August 2004

The finding of a number of peptides in the central nervous system and the discovery of the endogenous opiates represent major recent advances in the understanding of neural transmission. A number of these neuropeptides are found in the dorsal root entry zone and may play a role in pain. An analysis of changes in distribution of substance P, methionineenkephalin, and somatostatin after simulated nerve root avulsion injury suggested a possible mechanism for deafferentation pain. A review of the localizations and actions of these peptides in the dorsal root entry zone is included.
Spinal Peptidergic and Catecholaminergic Systems and Nociception
Authors: Howe J.R. , Zieglgänsberger W.
Published: August 2004

The authors review recent findings about the electrophysiology and anatomy of spinal peptidergic systems. The role of spinal catecholaminergic systems in nociception is also discussed. Recent data about the action of norepinephrine on dorsal horn neurons are presented.
Depression of Nociceptive Sensory Activity in the Rat Spinal Cord Due to the Intrathecal Administration of Drugs: Effect of Diazepam
Authors: Jurna Ilmar
Published: August 2004

The intrathecal (i.t.) administration of morphine inhibits nociceptive motor responses and activity in ascending axons evoked by stimulation of nociceptive afferent nerve fibers (nociceptive sensory response) in the rat. The i.t. administration of cholecystokinin octapeptide and ceruletide inhibits nociceptive motor responses, but does not affect ascending nociceptive activity. This shows that drug-induced depression of nociceptive motor responses is not always associated with depression of the nociceptive sensory response of the spinal cord. The microiontophoretic application of substance P excites single dorsal horn neurons that respond to noxious stimulation, whereas the i.t. administration of substance P inhibits both nociceptive motor and sensory responses. Thus, the results obtained from the i.t. administration of a drug may differ from those obtained from its application to single spinal neurons. Diazepam inhibits spinal reflexes and may reduce pain sensation in humans. To assess whether a spinal action is involved in the pain-relieving effect of diazepam, experiments were carried out on spinalized rats in which activity evoked by the stimulation of nociceptive and nonnociceptive afferent nerve fibers of the sural nerve was recorded from single ascending axons below the site of spinal cord transection. Diazepam, 20 ųg i.t., reduced activity evoked by afferent A delta and C fiber stimulation and by stimulation of afferent A beta fibers. The depressant effect caused by diazepam, 2 mg/kg i.v., on C fiber-evoked ascending activity was reduced by the i.t. injection of the benzodiazepine antagonist, Ro 15-1788 (40 ųg), an imidazodiazepine. It is concluded that the depression by diazepam of C fiber-evoked ascending activity contributes to pain relief caused by the drug.
Dorsal Root Rhizotomy and Avulsion in the Cat: A Comparison of Long Term Effects on Dorsal Horn Neuronal Activity
Authors: Ovelmen-Levitt Janice , Johnson Betty , Bedenbaugh Purvis , Nashold Blaine S.
Published: August 2004

We performed an extracellular microelectrode analysis of the neuronal activity of cells located in deeper laminae of dorsal horns that had been deafferented by ipsilateral lumbar dorsal root rhizotomy or avulsion. Special attention was given to those cells that were recorded in preparations that were more than 6 weeks chronic. We compared the results to those obtained in nondenervated controls and in experiments in which the spinal cord was acutely transected at a midthoracic level, but had intact dorsal roots. There was an increase in ipsilateral flank and contralateral input in the chronically deafferented as compared to nondenervated controls. Differences were observed between long term rhizotomized and avulsed dorsal horns. Receptive fields extended on to flank and thoracic dermatomes after rhizotomy, often requiring only light cutaneous stimuli. Receptive fields were more restricted with avulsion injury, generally requiring moderate to strong, superficial or deep pinch. Histological analysis revealed consistent differential damage to the medial portion of Lissauer's tract with avulsion injury and subsequently more gliosis in the substantia gelatinosa. The loss of this propriospinal pathway may explain the lack of receptive field expansion on to the thoracic dermatomes and the stronger natural stimuli that were required. A higher percentage of cells with bilateral and inhibitory receptive fields was found in experiments in which the spinal cord was transected at a midthoracic level than in the controls. Ipsilateral excitatory receptive fields were also expanded as compared with control observations, but were not found on the flank. It is concluded that descending fibers have an inhibitory influence on both excitatory and inhibitory receptive fields, both ipsilaterally and contralaterally, which can be released by acute spinal cord transection. These alterations or release from inhibition may form a substrate for observations made after dorsal root denervations.
Deafferentation Pain after Posterior Rhizotomy, Trauma to a Limb, and Herpes Zoster
Authors: Sweet William H.
Published: August 2004

After incisional or alcoholic destruction of trigeminal posterior rootlets, constant dysesthesias of major degree referred to some part of the markedly denervated zone develop in 5 to 15% of the patients. The full severity may not appear for weeks or months. There is no allodynia or hyperpathia of the denervated zone. Bulbar trigeminal tractotomy with sparing of touch sensation produces severe dysesthesias in a tiny percentage of the patients, as does selective destruction of pain fibers by radiofrequency heating or glycerol. Spinal posterior rhizotomy elicits in less than 4% a lasting dysesthesia entirely different in temporal sequence, locus, and type of pain: (a) it tends to be maximal early after operation and to improve, (b) the spontaneous pain is accompanied by severe allodynia, and (c) the pain is usually referred beyond the margins of the insentient (rhizotomized) zone and may even be referred to the corresponding area on the opposite side. Sindou's “selective posterior rhizotomy,” i.e., cutting of the small fiber lateral component of each rootlet as it enters the cord, has not given rise to dysesthesias. These do occur briefly in 50% of the cases following spinal ganglionectomy, the sensations being referred to the dermatomal segment of the ganglion in question. The secondary afferent neurons in the mesencephalic, principal, oral, and interpolar nuclei for the trigeminal posterior roots have no counterpart in the spinal cord for the spinal posterior roots. We suggest that the explanation for the fact that neither trigeminal neuralgia nor trigeminal anesthesia dolorosa have a spinal clinical counterpart is related to the as yet unexplained special functions of the elaborate trigeminal secondary afferent neuronal apparatus. Causalgia and sympathetic dystrophy share the fact of relief by sympathetic blockade, although only the former is associated with a sensory deficit. We conclude that the extent and nature of neural and other tissue damage are more important determinants of persistent pain than the fact of some denervation.
Chronic Pain in Paraplegics
Authors: Waisbrod H. , Hansen D. , Gerbershagen H.U.
Published: August 2004

The authors classify the three types of chronic pain in paraplegics: lesional area pain, projected pain, and triggered pain. The clinical description and proposed treatment for each type of pain are discussed.
Current Status of the DREZ Operation: 1984
Authors: Nashold Blaine S.
Published: August 2004

The DREZ operation was introduced in 1976 as a method to control deafferentation pain associated with brachial plexus injury. Since then, 250 DREZ operations have been done at Duke Medical Center. At present, the best results of pain relief occur in brachial and lumbosacral root avulsions, paraplegia, and postherpetic pain. Post-DREZ complications have been reduced by the introduction of new lesion techniques, including the recent use of the laser. The neural basis of deafferentation pain is still not solved, nor is the therapeutic effect of the DREZ lesion known.
Theoretical Aspects of Radiofrequency Lesions in the Dorsal Root Entry Zone
Authors: Cosman Eric R. , Nashold Blaine S. , Ovelman-Levitt Janice
Published: August 2004

The history and physical principles of radiofrequency (rf) lesion making are reviewed. The advantages of the rf lesion method are presented, with emphasis on its importance in small, critical regions such as the dorsal root entry zone (DREZ). The evolution and specifications of a satisfactory DREZ rf electrode are described. DREZ lesion sizes for this electrode at specific electrode tip temperatures were experimentally determined in animals and were used as a guide to determine acceptable clinical lesioning parameters. Emphasis is placed on lesion temperature monitoring and on the stability of electrode penetration into the spinal cord to achieve consistent and safe results.
Evoked Potentials as an Aid to Lesion Making in the Dorsal Root Entry Zone
Authors: Campbell J.A. , Miles John
Published: August 2004

The authors recorded evoked responses from superficial positions around the dorsal root entry zone as an aid to achieving accurate lesion making.
Thermocoagulation of the Dorsal Root Entry Zone for the Treatment of Intractable Pain
Authors: Samii Madjid , Moringlane Jean Richard
Published: August 2004

The authors report the results of DREZ thermocoagulation in 35 patients since March 1980. This technique was applied not only in patients with deafferentation pain after brachial plexus avulsion, but also for postamputation phantom limb pain and pain caused by injury to the spine and spinal cord, by peripheral nerve lesions, and by multiple sclerosis. Independent of etiology, the duration of the pain syndrome, and the quality and projection of the pain, the overall results have been satisfactory and long-lasting.
Dorsal Root Entry Zone Lesions for the Control of Deafferentation Pain: Experiences in Ten Patients
Authors: Richter Hans-Peter , Seitz Klaus
Published: August 2004

Experiences with radiofrequency lesions of the dorsal root entry zone in 10 patients are reported. All of these patients suffered from central (deafferentation) pain. The early postoperative results were poor in the 2 patients with traumatic paraplegia and good in all 8 patients with pain in the cervical segments. Two patients treated with cervical DREZ lesions died. In 2 of the remaining 6 patients with cervical lesions, pain recurred. Four had a good result up to 30 months after operation.
Primary Lymphoma of the Central Nervous System Diagnosed by Computed Tomographic Scan-directed Needle Biopsy with a Frozen Section Immunoperoxidase Technique
Authors: Pearl Gary S. , Chan Wing C. , Bakay Roy A. E. , Wood James H.
Published: August 2004

Primary lymphoma of the central nervous system is an uncommon neoplasm that requires definitive diagnosis because it is potentially treatable. We report a case in which the diagnosis of lymphoma was unsuspected and was made by needle biopsy with computed tomographic scan direction. A frozen section immunoperoxidase technique demonstrated monoclonality. When combined with a compatible morphological appearance, this confirmed the diagnosis of lymphoma. This case demonstrates the importance of this immunochemical method in the rapid diagnosis of central nervous system lymphomas. (Neurosurgery 16:1–4, 1985)
Experimental Carotid Aneurysms: Part 2
Authors: Kerber Charles W. , Cromwell Laurence D. , Zanetti Paul H.
Published: August 2004

Using our modification of the vein patch technique, we created 16 aneurysms in the common carotid arteries of dogs. After a stabilizing and healing period, these aneurysms were treated using percutaneous catheter techniques. Coaxial microcatheters were placed into the aneurysms, and a mixture of isobutyl 2-cyanoacrylate and tantalum dust was infused through the microcatheter using real time fluoroscopic control. Fifteen of the 16 aneurysms were successfully occluded; 1 was a failure because of total occlusion of the carotid artery. One human facial artery aneurysm was similarly treated. The ease and technical details of the treatment are discussed. Although the results are encouraging, we believe that it would be prudent to broaden the animal experimentation rather than to begin human use. Because no experimental aneurysm models are yet physiological, our results must be applied with caution to human intracranial aneurysms. (Neurosurgery 16:13–17, 1985)
Terminal Myelocystocele
Authors: McLone David G. , Naidich Thomas P.
Published: August 2004

Terminal myelocystoceles constitute approximately 5% of skin-covered lumbosacral masses and are especially common in patients with cloacal exstrophy. Pathologically, terminal myelocystocele consists of (a) a skin-covered lumbosacral spina bifida (b) an arachnoid-lined meninogocele that is directly continuous with the spinal subarachnoid space; and (c) a low-lying, hydromyelic spinal cord that traverses the meningocele and then expands into a large terminal cyst. The terminal cyst bulges into the extraarachnoid compartment caudal to the meningocele and forms a distal sac that does not communicate with the subarachnoid space. The terminal cyst is lined by ependyma and dysplastic glia, is directly continuous with the dilated central canal of the cord, and probably represents a ballooned terminal ventricle. Patients with terminal myelocystocele have normal intellectual potential and are usually born without neurological deficit, so these defects must be identified and repaired early, before the onset or progression of lower extremity pareses. (Neurosurgery 16:36–43, 1985)
Treatment of Cerebrospinal Fluid Rhinorrhea by Percutaneous Lumboperitoneal Shunting: Review of 15 cases
Authors: Bret Philippe , Hor Frédéric , Lapras Claude , Fischer Georges
Published: August 2004

Fifteen patients with recalcitrant cerebrospinal fluid (CSF) fistula underwent the insertion of a lumboperitoneal shunt. The shunt consists of a two-piece Silastic tube and has been used in a population of 150 patients with communicating hydrocephalus, persistent postoperative meningocele, and benign intracranial hypertension. The spinal catheter is introduced subcutaneously and no flushing device is used. We studied three groups: 9 patients had a history of head trauma, and 7 of these had undergone one or several ineffective direct approaches to the dural leak. Four patients presented with a presumably congenital fistula. Two patients had persistent rhinorrhea due to previous intracranial procedures. Indium-111 cisternography was performed in 10 patients before lumboperitonel (LP) shunting and failed in 2 of those to document the site of leakage. Twelve patients showed cessation of rhinorrhea after LP shunting. In 4 of these, shunt-related complications responded to shunt removal with no further recurrence of rhinorrhea. Two patients underwent revision of the shunt. In 3 patients, the LP shunt failed to control the CSF leak and further intracranial procedures were indicated. The LP shunt provides and attractive and technically simple solution when direct methods of treatment have failed. Additionally, LP shunting should be considered as a primary mode of treatment in elderly patients or when impairment of CSF dynamics is documented by radionuclide cisternography and computed tomographic scanning. When an LP shunt is ineffective, shunt function should be checked by isotopic studies before additional surgery is performed. (Neurosurgery 16:44–47, 1985)
Evaluation of Cerebrospinal Fluid Rhinorrhea by Metrizamide Computed Tomographic Cisternography
Authors: Ahmadi Jamshid , Weiss Martin H. , Segall Hervey D. , Schultz David H. , Giannotta Steven L.
Published: August 2004

Seven interesting and instructive cases of cerebrospinal fluid rhinorrhea evaluated by metrizamide computed tomographic cisternography are presented. The rhinorrhea was spontaneous in three patients and was related to previous head trauma or surgical procedures in four patients. The anatomical site and the extent of the fistula were demonstrated precisely by directly showing metrizamide passing through the bony defect. A combination of bone dehiscence and metrizamide within the adjacent paranasal sinuses or the nasal cavity is also useful in localization. Distortion of the interhemispheric fissure, sylvian fissure, or basal sulci indicates the probability of brain herniation through the defect. (Neurosurgery 16:54–60, 1985)
Fibrous Mass Complicating Epidural Morphine Infusion
Authors: Rodan Bruce A. , Cohen Fred L. , Bean William J. , Martyak Stephen N.
Published: August 2004

The benefits of continuous epidural morphine infusion using an implanted pump delivery system to control intractable cancer pain have recently been described. Most articles on this subject relate to dosage, technique, degree of pain relief, and tolerance. There are some anticipated complications of the treatment related to the surgical implantation of the system and drug toxicity. We present a complication presumably related to the epidural catheter. A fibrous reaction that developed around the catheter tip progressed into a mass. This caused a significant displacement of the spinal cord with the development of long tract symptoms. Identification of this abnormality using myelography and computed tomography led to prompt surgical decompression resulting in improvement of the patient's condition. (Neurosurgery 16:68–70, 1985)
Traumatic Decerebracy with Preserved Consciousness and Voluntary Movement
Authors: Pattisapu Jogi , Smith Robert R. , Bebin Jose , Wood James H.
Published: August 2004

Decerebrate rigidity is a frequent occurrence in cases of craniocerebral trauma. It is almost always accompanied by coma and usually denotes a poor prognosis. Primary focal brain stem lesions due to trauma are uncommon and may be accompanied by other diffuse cerebral lesions. This report reviews the anatomical basis and clinical findings of a unilateral brain stem lesion in a patient with traumatic decerebracy and preserved consciousness. The anatomical pathways and possible physiological mechanism are discussed, and a few comments on the prognosis of such lesions are given. (Neurosurgery 16:71–74, 1984)
Giant Cell Granuloma of the Orbit with Intracranial Extension
Authors: Sebag J. , Chapman P. , Truman J. , Riemersma R. R.
Published: August 2004

An 8-year-old boy presented with acute proptosis of the right eye. Examination revealed 8 mm of exophthalmos, limitation of upward gaze, optic disc swelling, and normal visual acuity, but an inferonasal quadrantic visual field defect. Orbital ultrasound and computed tomographic scanning demonstrated a superotemporal tumor of the right orbit with intracranial extension. At operation, this proved to be a “reparative” giant cell granuloma. After partial resection, the remaining mass resolved spontaneously without further specific treatment. There had been no recurrence at the 1-year follow-up examination. (Neurosurgery 16:75–81, 1985)
Malignant Melanoma of the Spinal Epidural Space Metastasized from the Enucleated Left Eye after Nine Years without Symptoms: Report of a Case
Authors: Yanai Yoshimi , Wakao Tetsuo , Fukamachi Akira , Kunimine Hideo , Wada Hirochiyo
Published: August 2004

A case of flaccid paraplegia due to a metastatic spinal epidural melanoma is reported. Symptoms occurred approximately 9 years after the enucleation of the left eye. A solid melanotic mass was removed almost totally. Three years after the operation, the patient had not regained the motility of the lower limbs. The need for long term follow-up and management of patients with such problems is discussed, and the pertinent literature is reviewed. (Neurosurgery 16:79–82, 1985)
Primary Pituitary Carcinoma: A Clinical Pathological Study
Authors: Nudleman Kenneth L. , Choi Ben , Kusske John A.
Published: August 2004

A 60-year-old woman presented with a history of headache and rapidly progressive complete bilateral ophthalmoplegia. Her endocrine function was normal. Radiographic studies revealed signs of diffuse destruction of the sella turcica by a tumor without suprasellar extension. Biopsies of the lesion within the sphenoid sinus demonstrated the presence of a primary pituitary carcinoma; autopsy findings revealed metastatic deposits in the liver, kidney, and lung. The histological characteristics of these cells and the electron microscopic findings confirmed that the tumor can first manifest themselves by the rapid development of unilateral or bilateral ophthalmoplegia; this diagnosis should be considered in all individuals with such a syndrome. (Neurosurgery 16:90–95,1985)
Atresia of the Foramen of Monro Resulting in Severe Unilateral Hydrocephalus with Subfalcial Herniation and Infratentorial Diverticulum
Authors: Oi Shizuo , Yamada Hiroshi , Sasaki Koji , Matsumoto Satoshi
Published: August 2004

A case of severe unilateral hydrocephalus associated with ventricular diverticulum and subfalcial herniation secondary to likely atresia of the foramen of Monro is presented. Both atresia of the foramen of Monro and ventricular diverticulum are rare conditions in hydrocephalus. The case presented here is the third reported case with both unique entities. (Neurosurgery 16:103–106, 1985)
Time Course and Spatial Distribution of Neodymium: Yttrium-Aluminum-Garnet (Nd:YAG) Laser-induced Lesions in the Rat Brain
Authors: Eggert Hans R. , Kiessling Marika , Kleihues Paul
Published: August 2004

Cerebral lesions made by focal neodymium: yttrium-aluminum-garnet (Nd: YAG) laser irradiation of the rat forebrain were studied in adult Wistar rats. For the analysis of time-dependent changes, the brains of 28 animals were irradiated with a constant energy density of 461 J/cm2. In this series, survival time ranged from 0.5 hours to 80 days. Immediately after irradiation, a circular lesion appeared on the surface of the brain. This lesion was surrounded by an edematous area intensively stained with Evans blue. At energy levels higher than 30 J, this circular edema contained numerous thrombosed vessels. Histopathologically, the lesion consisted of three distinct zones: the central coagulation necrosis was surrounded by a zone of delayed colliquation necrosis and by perifocal edema. At approximately 80 days after irradiation, the resulting cortical defect was covered by a pial membrane. Edematous changes of the brain cortex and the adjacent white matter were observed as early as 1 hour after irradiation. Within 16 hours, the perifocal edema spread over the white matter of both hemispheres, and it had disappeared by the 5th day after irradiation. In a second experiment, the energy density varied from 231 to 3077 J/cm2. This series consisted of 84 animals that were allowed to survive 48 hours. The size of the lesion depended on the level of energy applied, but the depth of the lesion varied less than the diameter at the brain surface. The depth ranged from 1.3 mm at 20 J to 3.1 mm at 140 J, and the diameter of the lesion at the brain surface varied from 1.3 mm at 15 J to 5.8 mm at 140 J. The results obtained suggest that the Nd: YAG laser can be used for tumor coagulation with minimal risk of adverse effects on the adjacent brain.
Comparison of the Effect of the Carbon Dioxide Laser and the Bipolar Coagulator on the Cat Brain
Authors: Cozzens Jeffrey W. , Cerullo Leonard J.
Published: August 2004

The carbon dioxide laser has recently received clinical acceptance in neurosurgical practice. There are, however, few studies reported in the neurosurgical literature, either clinical or experimental, concerning its safety or efficacy on a physiological level by comparison to a more conventional tool. This study is not a description of a surgical technique, but is rather a basic physiological comparison of two surgical instruments. In this study, 11 cats were pretreated with the protein-bound dye, Evans blue. A corticotomy was performed in one hemisphere with the carbon dioxide laser and in the other with a microbipolar coagulator and a sharp blade. The subsequent extravasation of dye was presumed to be proportional to the amount of blood-brain barrier disruption associated with each lesion. When effective power settings for the two devices were compared, the laser lesions had significantly less extravasation of blue dye. This indicated that there was less damage to the blood-brain barrier surrounding laser corticotomy than surrounding conventional bipolar coagulation and sharp dissection at comparable power settings for each modality.
Use of Antidromic Recording to Monitor Facial Nerve Function Intraoperatively
Authors: Richmond Isabelle L. , Mahla Michael
Published: August 2004

This report describes a technique for monitoring facial nerve activity intraoperatively utilizing antidromic nerve stimulation and sequential averaging of the evoked responses. Compound facial nerve action potentials are obtained reliably even in the presence of paralyzing doses of muscle relaxants, which render the conventional methods useless. The electrophysiological setup is straightforward, and we utilize the same sequential averaging equipment with which we monitor cortical evoked responses intraoperatively. This technique facilitates identification of the facial nerve in large cerebellopontine angel tumors with minimal mechanical trauma. Recordings from eight clinical cases are presented to illustrate the reliability and reproducibility of this technique.
Intraoperative Ultrasound for Spinal Lesions
Authors: Chadduck William M. , Flanigan Stevenson
Published: August 2004

A variety of spinal pathological processes demonstrated by intraoperative ultrasound is presented. Use of spinal ultrasound proved helpful in viewing alignment, assessing spinal cord pathology, and viewing anterior to the cord in cases of spinal trauma. As an operative adjunct, ultrasound was especially helpful for viewing extradural spinal metastases and cavitary lesions of the spinal cord, such as syrinxes, cystic tumors, and hematomas. In cases of spondylotic myelopathy, intraoperative ultrasound allowed assessment of the adequacy of the decompression, the space ventral to the cord, and the size and configuration of the spinal cord.
Aneurysms Associated with Moyamoya Disease
Authors: Konishi Yoshifumi , Kadowaki Chikafusa , Hara Mitsuhiro , Takeuchi Kazuo
Published: August 2004

Seven cases of moyamoya disease accompanied by an aneurysm were studied. The patients, two males and five females, were 13 to 57 years old (average, 32). The cases were classified into two groups: Group A (five cases), in which the aneurysm was located within the moyamoya vessels, and Group B (two cases), in which the aneurysm was located within the circle of Willis and remote from the moyamoya vessels. In all Group A cases, the presenting episode was intracerebral and intraventricular hemorrhage due to rupture of the aneurysm. One patient suffered two separate attacks. In this case, the aneurysm disappeared spontaneously. In one of the two Group B cases, there was hemorrhage from an anterior communicating artery aneurysm. In the other case, with a basilar-superior cerebellar artery aneurysm, there was hemorrhage from the moyamoya vessels.
Confirmation of Brain Death with Portable Isotope Angiography: A Review of 204 Consecutive Cases
Authors: Goodman Julius M. , Heck Larry L. , Moore Brian D.
Published: August 2004

Intravenous isotope angiography is a rapid, safe, and specific bedside test for confirming brain death by demonstrating the lack of critical cerebral perfusion that occurs in this condition, regardless of etiology. A review of 204 consecutive cases of suspected brain death studied with isotope angiography has reaffirmed our confidence in the specificity of the technique and has convinced us to make less stringent our radiographic criteria for confirming brain death by this method. A technically satisfactory single flow study that shows arrest of the carotid circulation at the base of the skull and absence of the intracranial arterial circulation may be considered confirmatory of a carefully established clinical diagnosis of brain death, even though there may be some visualization of the intracranial venous sinuses. Arbitrary waiting periods, withdrawal of sedative drugs, and electrophysiological studies are not needed when this technique is used.
Effect of Naloxone on Deficits after Aneurysmal Subarachnoid Hemorrhage
Authors: Bell B.A. , Miller J.D. , Neto N.G.F. , O'Neill P. , Laughton L.M.
Published: August 2004

The opiate antagonist naloxone was suggested for the amelioration of cerebral ischemia after subarachnoid hemorrhage (SAH) following the 1981 report of clinical improvement of ischemic deficits in 2 patients. The deficit in 1 patient was exacrebated by morphine, suggesting that analgesics acting on opiate receptors should be avoided after SAH, and this would include codeine phosphate and dihydrocodeine, both widely used for post-SAH headache. We studied 21 consecutive patients with aneurysmal SAH whose condition was worse than Grade 1 on the Hunt and Hess scale. A single observer graded them to avoid interobserver error, and they were also given a score on the Glasgow coma scale. Each patient was then given an intravenous injection of 0.9% saline as placebo or 0.4 mg (7 patients) or 2.0 mg (14 patients) of naloxone. Five minutes later, the same observer regraded the patient. After 30 minutes, a second injection of placebo or naloxone was given, and the patient was regraded a third time. Each patient received placebo in one injection and naloxone in the other, but the order was randomized and unknown to the observer. There was no beneficial effect of 0.4 mg of naloxone after aneurysmal SAH, and we did not find an elevated level of the endogenous opiate B-endorphin in the cerebrospinal fluid in the majority (6 of 8 of the patients in whom it was assayed). Five of the patients given 2.0 mg of naloxone did improve transiently, and none deteriorated after the drug, suggesting that naloxone in a high dose may have a place in the management of some post-SAH deficits. The lack of improvement after 0.4 mg of naloxone, which would adequately reverse codeine phosphate and dihydrocodeine, suggests no rationale for restricting normal doses of these drugs for post-SAH analgesia.