bluuebunny/crossref_metadata_2025 huggingface dataset:
Noncommunicating syringomyelia following occlusion of central canal in rats
Authors: Milhorat Thomas H. , Nobandegani Fariborz , Miller John I. , Rao Chandrakant
Published: May 2009

✓ This report describes a new and reliable technique for producing experimental noncommunicating syringomyelia. In 30 rats, 1.2 to 1.6 µl of kaolin was microinjected into the dorsal columns and central gray matter of the spinal cord at C-6. The inoculations caused transient neurological deficits in four animals and no deficits in 26 animals. Within 24 hours, kaolin and polymorphonuclear leukocytes entered the central canal and drained rostrally. The clearance of inflammatory products induced a proliferation of ependymal cells and periependymal fibrous astrocytes, which formed synechiae and obstructed the canal at the level of injection and at one or more levels up to C-1. In 22 animals followed for 48 hours or longer, the upper end of the central canal became acutely dilated and formed an ependyma-lined syrinx that enlarged to massive dimensions within 6 weeks. The rostral syrinxes did not communicate with the fourth ventricle and were not associated with hydrocephalus.

The histological findings in acute noncommunicating syringomyelia were characterized by progressive stretching and thinning of the ependyma, elongation of intracanalicular septae, and the formation of periependymal edema. After 3 weeks, there was progressive compression of the periependymal tissues associated with stretching of axons, fragmentation of myelin sheaths, and the formation of myelin droplets. These findings and the sequence in which they evolved were identical in most respects to those occurring in acute and subacute noncommunicating hydrocephalus.
Contralateral external carotid-to-middle cerebral artery graft using the saphenous vein
Authors: Kinugasa Kazushi , Sakurai Masaru , Ohmoto Takashi
Published: May 2009

✓ A variation of the extracranial-intracranial arterial bypass, using a long saphenous vein graft, is presented. The saphenous vein graft was inserted from the contralateral external carotid artery to the distal middle cerebral artery to replace the common and internal carotid arteries in a patient with a large neck tumor that invaded the common and internal carotid arteries, the esophagus, and the trachea. The patient had a positive balloon Matas' test. The saphenous vein was covered with an artificial vascular graft so that turning of the head or movement of the mandible did not displace or compress the graft. A large volume of flow began immediately after anastomosis. A description of the case and the operative technique is presented herein.
Intracranial xanthogranuloma of the dura in Hand-Schüller-Christian disease
Authors: Jamjoom Zain Alabedeen B. , Raina Vinita , Al-Jamali Abdulfattah , Jamjoom Abdulhakim B. , Yacub Basim , Sharif Hassan S.
Published: May 2009

✓ The authors describe a 37-year-old man with the classic clinical features of Hand-Schüller-Christian disease. He presented with symptoms of increased intracranial pressure due to obstructive hydrocephalus secondary to a huge xanthogranuloma involving falx cerebri and tentorium cerebelli. Immunohistochemical and ultrastructural studies failed to demonstrate Langerhans histiocytes, however. The implication of this finding is discussed in light of the recent relevant literature.
The Duke University Medical Center
Authors: Wilkins Robert H. , Sabiston David C.
Published: May 2009

✓ The events leading up to the creation of Duke University, the Duke University School of Medicine, and Duke Hospital are reviewed. The efforts of many individuals during more than 80 years were rewarded by an endowment and then a bequest by James B. Duke that converted Trinity College into Duke University and made possible the origination of its Medical Center. The first neurosurgical operation at the new hospital was performed on July 24, 1930, the fourth day it was open.
Therapeutic alternatives for vein of Galen vascular malformations
Authors: Lylyk Pedro , Viñuela Fernando , Dion Jacques E. , Duckwiler Gary , Guglielmi Guido , Peacock Warwick , Martin Neil
Published: May 2009

✓ From September, 1986, to March, 1990, the authors treated 28 children harboring a vein of Galen vascular malformation. Eleven (39.3%) of the patients were neonates, 13 (46.4%) were 1 to 2 years old, and four (14.3%) were more than 2 years old.

Fifteen patients (53.6%) presented with severe congestive heart failure, six (21.4%) had seizures, four (14.3%) had hydrocephalus, and three (10.7%) presented with intraventricular hemorrhage. Based on the Yaşargil classification of malformations, 10 lesions (35.7%) were Type I, seven (25%) were Type II, eight (28.6%) were Type III, and three (10.7%) were Type IV. In 11 patients (39.3%), a combined transfemoral, transarterial, and transvenous embolization of the vein of Galen malformation was performed. A pure transtorcular approach was utilized in eight patients (28.6%), and postembolization surgical clipping of arterial feeders was performed in two cases with intractable congestive heart failure.

Complete anatomical occlusion of the galenic malformation was achieved in 13 patients (46.4%). An immediate postembolization improvement in the patient's clinical status was obtained in 23 (82.1%) of 28 patients and a good long-term clinical outcome was seen in 17 patients (60.7%). Five deaths (17.9%) occurred in this series of 28 patients; three (10.7%) were related to a transtorcular embolization and two (7.1%) to the unchanged natural history of the disease.
The plated bayonet: a new instrument to facilitate surgery for intra-axial neoplasms of the spinal cord and brain stem
Authors: Epstein Fred J. , Ozek Memet
Published: May 2009

✓ A new instrument for use in surgically treating intra-axial neoplasms of the spinal cord and brain stem is described. The plated bayonet allows neoplastic tissue in the spinal cord to be separated from functioning neural elements without perforating the adjacent spinal cord. In addition, the plated bayonet facilitates exposure through the very small incision necessary to remove tumors of the brain stem without damaging cranial nerves or other vital structures.
Posterior fossa craniotomy for lesions of the cerebellopontine angle
Authors: Ogilvy Christopher S. , Ojemann Robert G.
Published: May 2009

✓ A safe technique is described for performing a lateral posterior fossa craniotomy to gain access to the cerebellopontine angle. The method makes use of currently available high-speed air drills. Thus, it is possible to replace the removed bone at the conclusion of the procedure and to re-establish normal tissue planes while providing rigid protection to the posterior fossa.
Radiosurgery for venous angiomas
Authors: Lindquist Christer , Guo Wan-Yio , Karlsson Bengt , Steiner Ladislau
Published: May 2009

✓ Radiosurgical treatment with the gamma knife for venous angiomas was used as an alternative to microsurgical removal in order to avoid abrupt cessation of venous drainage, which may be shared by the venous angioma and important parts of the brain. Thirteen cases of venous angioma were treated between 1977 and 1991. In two cases cavernous angiomas were also present and in one case a distant arteriovenous malformation (AVM) was also found. In two cases the angioma shared the venous drainage with an adjoining AVM; this is the first description of such pathology. For venous angiomas irradiation was prescribed to cover at least the convergence of the medullary veins. For AVM's close to a venous angioma the treatment was exclusively prescribed to the AVM nidus. After treatment, complete obliteration of the venous angioma was observed in one case, partial obliteration was observed in three cases, and five venous angiomas were unaffected by the treatment. Undue effects of radiation occurred in four cases: one focal edema and three radionecroses. Extirpation of the radionecrotic tissue 6 months after radiosurgery was necessary in one case. In the other three cases, the venous angioma was observed to be completely or partially obliterated, or unaffected by the treatment (one case each). In two cases of combined AVM and venous angioma, complete obliteration of the treatment AVM nidus was obtained. It is concluded that radiosurgery for venous angioma, although conceptually attractive, still does not fulfill the rigid criteria of minimal risk which must be set for the treatment of a lesion with a benign natural history.
A randomized controlled trial of high-dose intravenous nicardipine in aneurysmal subarachnoid hemorrhage
Authors: Haley E. Clarke , Kassell Neal F. , Torner James C. , _ _
Published: May 2009

✓ Because of their action as cerebral vasodilators, dihydropyridine calcium antagonists have received intense scrutiny for their potential benefit in ameliorating the devastating consequences of delayed cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH). From October, 1987, to September, 1989, 41 North American neurosurgical centers in the Cooperative Aneurysm Study accrued 906 patients with recent (Days 0 to 7) aneurysmal SAH into a prospective randomized double-blind placebo-controlled trial of high-dose intravenous nicardipine to test whether treatment with this agent improved overall outcome. Eligible patients received 0.15 mg/kg/hr of either nicardipine or placebo by continuous infusion for up to 14 days following hemorrhage. The 449 patients randomly assigned to the nicardipine-treated group and the 457 patients assigned to the placebo-treated group were balanced with regard to prognostic factors for ischemic deficits from vasospasm and for overall outcome. Other medical and surgical interventions were used with similar frequency in both groups, except that antihypertensive agents were used less frequently in the nicardipine-treated patients (26% of the nicardipine-treated group vs. 43% of the placebo-treated group, p < 0.001), and more patients in the placebo-treated group had intentional hypervolemia, induced hypertension, and/or hemodilution administered therapeutically for symptomatic vasospasm (38% of the placebo-treated group vs. 25% of the nicardipine-treated group, p < 0.001). The incidence of symptomatic vasospasm during the treatment period was higher in the placebo-treated group (46%) than in the nicardipine-treated group (32%) (p < 0.001). Despite the reduction in symptomatic vasospasm in the nicardipine-treated group, overall outcome at 3 months was similar between the two groups. Fifty-five percent of nicardipine-treated patients were rated as having a good recovery according to the Glasgow Outcome Scale at follow-up review and 17% were dead, compared to 56% and 18%, respectively, in the placebo-treated group (not statistically significant).

These data suggest that high-dose intravenous nicardipine treatment is associated with a reduced incidence of symptomatic vasospasm in patients with recent aneurysmal SAH, but not with an improvement in overall outcome at 3 months when compared to standard management in North America. It is postulated that, while nicardipine prevents vasospasm, hypertensive/hypervolemic therapy may be effective in reversing ischemic deficits from vasospasm once they occur.
Management outcome in the elderly patient following subarachnoid hemorrhage
Authors: Inagawa Tetsuji
Published: May 2009

✓ The purpose of this study was to investigate whether the overall management outcome for elderly patients with subarachnoid hemorrhage (SAH), especially for those aged 70 to 79 years, has improved. To this end, the author compared data for the period between 1986 and 1990 (Study Period 2) with those obtained between 1980 and 1985 (Study Period 1). Of 503 patients who were admitted by Day 3 after SAH during the two study periods, 243 (48%) were 59 years of age or younger, 129 (26%) were 60 to 69 years of age, 102 (20%) were 70 to 79 years of age, and 29 (6%) were 80 years of age or older. The percentage of patients aged 70 years or more doubled from 17% during Study Period 1 to 34% during Study Period 2. During Study Period 1, the older patients had a lower operability rate; during Study Period 2, the operability rate for patients aged 70 to 79 years (69%) was similar to that for patients aged 50 to 69 years. At 6 months after SAH for patients aged 70 to 79 years, the overall management and surgical results of good recovery or moderate disability were 18% and 36%, respectively, during Study Period 1, and improved to 41% and 60%, respectively, during Study Period 2. During Study Period 1, the cumulative 5-year survival probabilities for overall management were 59% for patients aged 59 years or less, 53% for those aged 60 to 69 years, and 24% for those aged 70 to 79 years; during Study Period 2, these probabilities improved to 70%, 58%, and 47%, respectively. The 5-year survival rates of surgically treated patients in these three age groups increased from 77%, 68%, and 44% to 88%, 77%, and 69%, respectively.
Lund University and its neurobiological traditions
Authors: Westling Håkan
Published: May 2009

✓ Lund University was founded in 1666 as part of a strategy to assimilate the province of Scania in southern Sweden, which had been obtained from Denmark after a war ending in 1658. The present main building was erected in 1882. The University Hospital and the medical departments are located in the campus area northeast of the building.

The main strength of the medical faculty lies in the neuro-biosciences. In retrospect, they offer a fascinating development with interesting historical connections as well as present-day contacts between many scientific disciplines. This shows once again that real scientific progress requires the interaction of many brains; in other words, the cross-fertilization offered by a critically large mass of scientists from different fields working relatively close together over long periods of time.
Intracranial chordomas: a clinicopathological and prognostic study of 51 cases
Authors: Forsyth Peter A. , Cascino Terrence L. , Shaw Edward G. , Scheithauer Bernd W. , O'Fallon Judith R. , Dozier James C. , Piepgras David G.
Published: May 2009

✓ Fifty-one patients with intracranial chordomas who were surgically treated between 1960 and 1984 were studied. Median patient age was 46 years, and 73% presented with diplopia or headache. Nineteen tumors were classified as the “chondroid” type. The extent of surgical removal was a biopsy in 11 patients and subtotal removal or greater in 40. Thirty-nine patients received postoperative radiation therapy. At the time of analysis, 17 patients were alive, and the estimated 5- and 10-year survival rates were 51% and 35%, respectively, for the group of 51 patients. Univariate analysis showed that: 1) patients undergoing resection lived longer (the 5-year survival rate was 36% for the 11 biopsy patients compared with 55% for the 40 patients who had resection; 2) patients who underwent postoperative radiotherapy tended to have longer disease-free survival times; and 3) overall and disease-free survival data were the same for patients with chondroid tumors and those with typical chordomas. Multivariate analysis showed that: 1) age was the factor most strongly associated with longer overall and disease-free survival; 2) diplopia was associated with longer survival; and 3) tumoral mitotic activity tended to be associated with shorter disease-free survival. One tumor metastasized to the cervical cord, and two tumors underwent anaplastic transformation. These data suggest that the prognosis in patients with chordomas is unfavorable, young age is the single factor most strongly associated with longer survival, surgical resection is beneficial, and postoperative radiotherapy may prolong disease-free survival.
Lumbosacral neurenteric cyst in an infant
Authors: Ledoux Mark S. , Faye-Petersen Ona M. , Aronin Patricia A. , Vaid Yoginder N. , Pitts R. Marshall
Published: May 2009

✓ The case of a combined intra- and extraspinal neurenteric cyst in an infant is reported. This case is unique because an intraspinal cyst was not suspected clinically until large numbers of squamous epithelial cells were obtained at lumbar puncture performed as part of a workup for a septic entity. The cyst extended from an intradural location ventral to the conus medullaris at L-1 through a ventrolateral defect in the S-4 vertebral body to communicate with a large presacral component. The entire cystic cavity was lined by stratified squamous epithelium. The possible pathogenesis of this lesion is discussed.
Altered cerebrovascular CO2 reactivity following subarachnoid hemorrhage in cats
Authors: Diringer Michael N. , Kirsch Jeffrey R. , Hanley Daniel F. , Traystman Richard J.
Published: May 2009

✓ The authors tested the hypothesis that cerebral blood flow (CBF) reactivity to CO2 was blunted following subarachnoid hemorrhage (SAH). Subarachnoid hemorrhage was produced in five cats by performing four cisterna magna injections of blood in each (SAH Group). A second group of six cats was treated with an antifibrinolytic agent (AF) in addition to four cisterna magna blood injections (SAH + AF Group). Four cats received AF and four cisterna magna injections of saline (Control Group). The presence or absence of basilar artery vasospasm was determined by comparing baseline and follow-up selective angiograms. Cerebral blood flow reactivity was determined by randomly varying the concentration of inspired CO2 to alter PaCO2 from 20 to 75 mm Hg. Regional CBF was measured with radiolabeled microspheres. Basilar artery vasospasm was seen following subarachnoid injection of blood but not of saline. Normocapnic CBF was similar in all three groups in the brain stem (mean ± standard error of the mean: SAH Group 46 ± 6, SAH + AF Group 46 ± 6, and Control Group 44 ± 9 ml/min/100 gm) and in the supratentorial compartment (SAH Group 53 ± 8, SAH + AF Group 61 ±9, and Control Group 51 ± 13 ml/min/100 gm). At intermediate levels of hypercarbia (PaCO2 50 ± 3 mm Hg), CBF increased similarly in all three groups (SAH Group 161% ± 32%, SAH + AF Group 118% ± 33%, and Control Group 174% ± 19% compared to baseline); at higher levels of PaCO2 (60 ± 3 mm Hg), CBF values were SAH Group 265% ± 50%, SAH + AF Group 205% ± 47%, and Control Group 159% ± 30% of baseline. At the highest level of PaCO2 (75 ± 6 mm Hg), supratentorial CBF did not increase as much in the SAH + AF Group as in the Control Group (179% ± 59% vs. 463% ± 58% of baseline, respectively). The authors conclude that, in this model of SAH, there is no change in normocapnic CBF; however, blood flow reactivity to hypercarbia is blunted. It is possible that this may result from a combination of narrowing of proximal large vessels and globally impaired reactivity of small vessels.
The effect of transforming growth factor-β2-specific phosphorothioate-anti-sense oligodeoxynucleotides in reversing cellular immunosuppression in malignant glioma
Authors: Jachimczak Piotr , Bogdahn Ulrich , Schneider Jörg , Behl Christian , Meixensberger Jürgen , Apfel Rainer , Dörries Rüdiger , Schlingensiepen Karl-Hermann , Brysch Wolfgang
Published: May 2009

✓ This in vitro study was aimed at restitution of transforming growth factor (TGF)-β2-mediated suppression of T-lymphocyte activation within malignant gliomas. In early-passage tumor cell cultures of two glioblastomas (HTZ-153 and HTZ-209) and one malignant astrocytoma classified as World Health Organization Grade III (HTZ-243), autologous peripheral blood mononuclear cells were activated by interleukin-lα and interleukin-2 in vitro (lymphokine-actived killer cells) and tested for cytotoxic and proliferative activity. In expression studies (Western blot and Northern hybridization) of all three tumors, TGF-β could be detected at the protein and messenger ribonucleic acid (mRNA) levels. A polyclonal anti-TGF-β neutralizing antibody did not enhance lymphocyte proliferation upon stimulation with tumor targets (3H-thymidine incorporation) and slightly stimulated lymphocyte cytotoxicity against autologous target cells. Preincubation of target cells for 12 hours with TGF-β2-specific phosphorothioate-anti-sense oligodeoxynucleotides (S-ODN's) did, however, enhance lymphocyte proliferation up to 2.5-fold and autologous tumor cytotoxicity up to 60%, compared to controls not treated with S-ODN's. Incubation of tumor cells with TGF-β2-specific S-ODN's resulted in decreased TGF-β-specific immunoreactivity in cultured glioma cells, in reduced TGF-β2 protein concentration (Western blot), and in a change in the expression pattern of TGF-β2 mRNA's. These observations may have implications for in vivo and in vitro activation of a cellular immune response against autologous malignant glioma cells.
Effect of recombinant tumor necrosis factor-α on three-dimensional growth, morphology, and invasiveness of human glioblastoma cells in vitro
Authors: Iwasaki Koichi , Rogers Lisa R. , Barnett Gene H. , Estes Melinda L. , Barna Barbara P.
Published: May 2009

✓ In order to investigate the antiproliferative and anti-invasive effects of tumor necrosis factor (TNF)-α on human glioblastoma cells, an in vitro three-dimensional (anchorage-independent) assay was performed using Matrigel, a mixture of extracellular matrix proteins. Four glioblastoma-derived cell lines, including one cloned line, were cultured in Matrigel with or without TNF-α. In the Matrigel containing TNF-α, three of the four cell lines, including the cloned line, showed significant growth inhibition in a dose-dependent manner. Dramatic three-dimensional morphological differences were observed between TNF-treated and untreated glioblastoma cells cultured in Matrigel. Untreated cells formed large and highly branched colonies throughout the gel. In contrast, the majority of TNF-treated cells demonstrated truncated branching processes and, at a high TNF-α dose, an increasing number of cells remained in relatively small spherical aggregates, their cell processes being significantly reduced. Quantitative invasion assay using a micro-Boyden chamber system confirmed that TNF-treated cells lost invasiveness in a dose-dependent manner. These results suggest that TNF-α exerts not only antiproliferative but also anti-invasive effects on human glioblastoma cells in vitro. It is believed that this is the first report showing the anti-invasive effect of TNF-α on tumor cells.
A brain-tumor model utilizing stereotactic implantation of a permanent cannula
Authors: Morreale Vittorio M. , Herman Barbara H. , Der-Minassian Violette , Palkovits Miklós , Klubes Phillip , Perry David , Csiffary Attila , Lee Alex P.
Published: May 2009

✓ A tumor model involving stereotactically implanted culture-reared tumor cells is presented. Stainless steel cannulas were stereotactically and permanently implanted into the caudate nucleus of 30 rats. The animals were separated into two groups. In Group I, 15 animals received a 10-µl injection containing 106 C6 glioblastoma cells (five rats), 106 Walker 256 breast carcinoma cells (five rats), or cell medium (five rats). The coordinates were A(+1.5), L(+3.0), and DV(−5.0). In Group II, the coordinates were changed to A(+1.0), L(+3.0), and DV(−5.0) and the same number of rats received a 1-µl injection containing 105 cells of each tumor in an attempt to produce more focal tumors. Two weeks after implantation, brain sections were stained with cresyl violet and a subset was stained for glial fibrillary acidic protein (GFAP). A computerized morphometric analysis system was used to quantify tumor size. In Group I, the mean C6 tumor areas (± standard error of the mean) at specific coordinates were (in sq mm): A(+4.7) 0.4 ± 0.2; A(+3.7) 3.5 ≥ 1.1; A(+2.7) 5.7 ± 1.7; A(+1.7) 9.5 ± 2.3; A(+0.7) 7.5 ± 3.2; A(−0.3) 3.7 ± 2.9; and A(−1.3) 0.3 ± 0.3. A nearly identical tumor mass and extension into the brain was produced in rats injected with Walker 256 cells. Similar C6 tumor areas were indicated in adjacent sections stained with cresyl violet and GFAP. Tumor was found in the caudate nucleus in all 10 rats, but not in the nucleus accumbens, fornix, or hippocampus. In Group II animals, tumor magnitude and extension into the brain were greatly reduced. The 106 cells in the 10-µl volume was the most reliable tumor load for obtaining uniform tumors in different animals. The similarity of tumor distribution across different animals was indicated by the low variance of tumor area at specific anteroposterior coordinates. Reproducible and well-circumscribed caudate nucleus tumors were produced using this stereotactic procedure.
Myelomeningocele and thick filum terminale with tethered cord appearing as a human tail
Authors: Chakrabortty Shushovan , Oi Shizuo , Yoshida Yasuhisa , Yamada Hiroshi , Yamaguchi Michio , Tamaki Norihiko , Matsumoto Satoshi
Published: May 2009

✓ Tail-like caudal appendages may be associated with spinal dysraphism, particularly with spinal lipomas or lipomyelomeningoceles. An unusual case is presented of a patient with a myelomeningocele and a thick filum terminale with tethered spinal cord, which presented with the external appearance of a human tail. A review of the literature reveals that human tails may be associated with dysraphic conditions. Extensive neuroradiological examinations should be performed for all such cases of apparent tails.
Transcallosal interforniceal approach for a posteriorly projecting high basilar bifurcation aneurysm
Authors: Abe Toshiaki , Sugishita Morihiro , Yatsuzuka Satoshi , Tashibu Koichi , Onoue Hisashi , Suzuki Takashi , Nakamura Norio
Published: May 2009

✓ A transcallosal interforniceal approach was used for treatment of a posteriorly projecting high basilar bifurcation aneurysm with a neck located 30 mm above the posterior clinoid process. The aneurysm was successfully clipped via the third ventricle with minimal neurological deficits. This approach appears to be appropriate for basilar bifurcation aneurysms located more than 20 mm above the posterior clinoid process when the fundus projects posteriorly, and permits direct visualization of the aneurysmal neck and vital perforators with minimal brain retraction.
Giant serpentine middle cerebral artery aneurysm treated by extracranial-intracranial bypass
Authors: Greene Karl A. , Anson John A. , Spetzler Robert F.
Published: May 2009

✓ Giant intracranial aneurysms often pose difficult management issues. Such aneurysms may not be amenable to direct surgical attack because of their size, location, or lack of a clear aneurysmal neck. In such cases, a combination of strategies may provide a means of proximal aneurysm occlusion and distal cerebral revascularization.

The authors report the successful treatment of a giant (186.8-ml) serpentine aneurysm of the left middle cerebral artery (MCA) in a 14-year-old boy. The aneurysm was managed in a two-stage procedure in which the MCA branches distal to the aneurysm were anastomosed first with branches of the left superficial temporal artery. After the bypass procedure, direct occlusion of the MCA was performed at the proximal base of the aneurysm at its site of dilatation. The patient had no intraoperative or postoperative complications and was intact neurologically 6 months following the procedures.
Optic nerve ganglioglioma
Authors: Lu William Y. , Goldman Marc , Young Byron , Davis Daron G.
Published: May 2009

✓ Gangliogliomas of the optic nerve are extremely rare. The case is reported of a 38-year-old man who presented with a visual field deficit and was discovered to have an optic nerve ganglioglioma. The possible embryological origins of this neoplasm, its histological and immunohistochemical features, and its appearance on magnetic resonance imaging are examined. The prognoses of optic nerve glioma and of gangliogliomas occurring elsewhere in the nervous system are compared.
Superficial temporal artery interposition graft after resection of bilateral anterior cerebral arteries
Authors: Kinugasa Kazushi , Maeshiro Tomohide , Sakurai Masaru , Ohmoto Takashi
Published: May 2009

✓ A patient with an olfactory neuroblastoma in the frontal skull base was treated with primary tumor excision and partial resection of the A2 segment of both anterior cerebral arteries (ACA's). Revascularization was carried out using a superficial temporal artery (STA) interposition graft between the proximal and distal stumps with A3 segment-to-A3 segment end-to-side anastomosis. This technique established flow to the peripheral territories of the ACA's through the interposed STA graft. The technical aspects and possible role of this procedure are presented.
Grading venous restrictive disease in patients with dural arteriovenous fistulas of the transverse/sigmoid sinus
Authors: Lalwani Anil K. , Dowd Christopher F. , Halbach Van V.
Published: May 2009

✓ Dural arteriovenous fistulas of the transverse/sigmoid sinus usually cause pulse-synchronous bruit but may present catastrophically. Current systems for classifying these vascular malformations do not consider obstruction of venous outflow, which increases the risk of intracranial hemorrhage due to retrograde flow via cortical veins. The authors have developed a grading system based on the severity of venous restrictive disease determined by superselective angiography. In a retrospective analysis of 25 patients with dural arteriovenous fistulas of the transverse/sigmoid sinus treated between 1988 and 1990, the grade of venous restrictive disease reflected the clinical presentation. Visual symptoms and central nervous system hemorrhage were more common in patients with cortical venous drainage and more severe distal venous occlusion (Grade 3: 31% and 31%, respectively; Grade 4: 67% and 100%, respectively) than in patients with cortical venous drainage and mild-to-moderate venous restrictive disease (Grade 2: 13% and 0%, respectively) or those without venous outflow (Grade 1: 0% and 0%, respectively). These preliminary results suggest that this grading system may be useful for predicting the risk of catastrophic clinical presentation and for guiding therapeutic decision-making in patients with dural arteriovenous fistulas of the transverse/sigmoid sinus. A prospective study of a larger number of patients is needed to validate the predictive value of this new grading system.
Preservation of olfaction in anterior craniofacial approaches
Authors: Spetzler Robert F. , Herman James M. , Beals Stephen , Joganic Edward , Milligan John
Published: May 2009

✓ Through the combined efforts of neurosurgeons, head and neck surgeons, and craniofacial surgeons, the standard transbasal approach to the frontal fossa has been modified to include removal of the orbital roofs, nasion, and ethmoid sinuses. This approach has been combined further with facial disassembly procedures to provide extensive midline exposure to the midface and clival region. Extended frontal approaches, however, necessitate removal of the crista galli and sectioning of the olfactory rootlets with the associated risk of anosmia, cerebrospinal fluid (CSF) leak, and the need for complex reconstruction of the frontal floor. To avoid these problems, the authors have modified the technique of handling the cribriform plate to preserve the olfactory unit.

Circumferential osteotomy cuts are made around the cribriform plate to allow an en bloc removal with its attachment to both the dura and underlying mucosa. Opening of the dura is avoided and the cribriform bone is used to reconstruct the floor. Four patients underwent this approach, for treatment of an angiofibroma in three and a fibrosarcoma in one. The mean follow-up period was 7 months. No patients developed a CSF leak, and within 8 weeks olfaction had returned in all patients. There was no other associated morbidity. These data suggest that this modification of the transbasilar approach can alleviate extensive reconstructive procedures and CSF leaks while preserving olfaction.
Pathology of temporal lobectomy for refractory seizures in children
Authors: Jay Venita , Becker Laurence E. , Otsubo Hiroshi , Hwang Paul A. , Hoffman Harold J. , Harwood-Nash Derek
Published: May 2009

✓ Significant pathological abnormalities were encountered in a series of 20 temporal lobectomies in children with intractable complex partial seizures. In particular, “dual pathology” (mesial temporal sclerosis with other lesions) was found rather than mesial temporal sclerosis as the only lesion. Unusual pathological findings included capillary penetration of neurons in a neuronal heterotopia in one patient, and foci of extensive cortical disorganization in some cases of mixed tumors and gangliogliomas. A high proportion of neuronal migration disorders was also seen with overlapping pathological features between cortical dysplasia and tuberous sclerosis. In this correlative clinical, radiological, electroencephalographic, and pathological study, some of the pathological lesions in children did not fit the classical categories of neoplasia and malformation and transitional forms were rarely encountered.
Cervical neural foraminal canal stenosis: computerized tomographic myelography diagnosis
Authors: Houser O. Wayne , Onofrio Burton M. , Miller Gary M. , Folger W. Neath , Smith Patsy L. , Kallman Douglas A.
Published: May 2009

✓ The surgical and computerized tomographic myelography (CTM) features of 134 stenotic foraminal canals were correlated retrospectively in 95 patients. The myelographic site of stenosis was the entrance to the foraminal canal in 70 cases (52%) and the canal itself in 37 (28%); the site was not identified definitively in 27 (20%). At the entrance to the foraminal canal, encroachment on the adjacent nerve root was by a cartilaginous cap in 10 cases (8%), a bony osteophyte in 17 (13%), a synovial cyst in one (1%), and a combination of a bony and cartilaginous osteophyte in 42 (31%). The diagnostic features of stenosis within the foraminal canal were more variable. Small bone spurs arising from the uncovertebral process encroached on the anterior aspect of the foramen in 29 instances (22%), accompanied in all cases by either a congenitally narrow canal (in 16) or a diffuse osteophytically narrowed canal (in 13); osteophytes arising from the superior facet in eight instances (6%) were larger and encroached on the posterior aspect of the foramen. Diagnosis on the basis of CTM is difficult because stenosis was readily evident as a bone spur in only 13% of cases, could not be distinguished from prolapsed disc in 39%, had to be differentiated from a congenitally narrow foraminal canal in 27%, and was frankly missed in 20% of the instances of stenosis.
The reduction of postlaminectomy peridural fibrosis in rabbits by a carbohydrate polymer
Authors: Robertson James T. , Meric Albert L. , Dohan F. Curtis , Schweitzer John B. , Wujek Jerome R. , Ahmad Shafik
Published: May 2009

✓ Spinal peridural fibrosis following total laminectomy in New Zealand White rabbits was significantly decreased by the intraoperative application of GT1587, a semi-synthetic carbohydrate polymer. The application of a similar polymer, GT1043, or phosphate-buffered saline (PBS) was not as effective. Laminectomies were performed at L-2 and L-4 in 25 rabbits. Absorbable gelatin sponge soaked with GT1043, GT1587, or PBS was applied in a blinded fashion to the operative sites, with untreated (sham) laminectomy sites serving as controls. Animals were sacrificed after 2 or 4 weeks. The extent of peridural fibrosis was evaluated by gross microdissection and histological analysis. Dense scar formation and dural adhesions were evident at both time intervals in the sham- and PBS-treated laminectomy sites. The sites treated with GT1587 showed significantly decreased peridural scar formation and dural adhesions, whereas GT1043 treatment caused modest reduction of scar formation at only the 2-week examination. The healing of skin and lumbosacral fascia was not affected by treatment of the laminectomy site with GT1587. These results suggest that GT1587 may prove beneficial in preventing postlaminectomy dural adhesions and peridural fibrosis in humans.
Severe phenytoin-induced bone marrow depression and agranulocytosis treated with human recombinant granulocyte-macrophage colony-stimulating factor
Authors: Rawanduzy Ahmed , Sarkis Antoine , Rovit Richard L.
Published: May 2009

✓ An unusual instance of severe and potentially lethal depression of the bone marrow is described as a result of the administration of phenytoin for seizure prophylaxis. The patient was treated successfully by prompt cessation of phenytoin and intravenous administration of human recombinant granulocyte-macrophage colony-stimulating factor.
Megakaryoblastic leukemia presenting as a temporal bone granulocytic sarcoma
Authors: Kaufman Bruce A. , Jones Lori , Zutter Mary M. , Park T. S.
Published: May 2009

✓ The unusual presentation of acute megakaryoblastic leukemia as a temporal bone granulocytic sarcoma in an infant without systemic manifestations of leukemia is reviewed. Leukemia should be considered in the differential diagnosis of skull and skull-based lesions since the appearance on neuroradiological imaging is not unique in this diagnosis. Surgical treatment, as in this case, is limited to obtaining tissue for diagnosis and draining the infection.
Cervical-to-petrous internal carotid artery bypass procedure
Authors: Fitzpatrick Brian C. , Spetzler Robert F. , Ballard Jeffrey L. , Zimmerman Richard S.
Published: May 2009

✓ The technique for cervical-to-petrous internal carotid artery saphenous vein bypass is described. This procedure was used in the treatment of three patients with high cervical or skull base vascular injuries. All grafts were patent on follow-up angiography.
Posterior atlantoaxial facet screw fixation
Authors: Marcotte Paul , Dickman Curtis A. , Sonntag Volker K. H. , Karahalios Dean G. , Drabier Janine
Published: May 2009

✓ Eighteen patients with atlantoaxial instability were treated with posterior atlantoaxial facet screws to obtain immediate rigid fixation of C1–2. Of these 18 patients, instability occurred due to trauma in nine, rheumatoid arthritis in six, neoplasms in two, and os odontoideum in one. Four patients presented with nonunion after failed C1–2 wire and graft procedures. In all cases in this series the screw fixations were augmented with an interspinous C1–2 strut graft which was wired in place to provide three-point stabilization and to facilitate bone fusion. In every case fixation was satisfactory, and C1–2 alignment and stability were restored without complications due to instrumentation. One patient died 3 months postoperatively from metastatic tumor; the spinal fixation was intact. All 17 surviving patients have developed osseous unions (mean follow-up period 12 months, range 6 to 16 months). Posterior atlantoaxial facet screw fixation provides immediate multidirectional rigid fixation of C1–2 that is mechanically superior to wiring or clamp fixation. This technique maximizes success without the need for a supplemental rigid external orthosis, and is particularly useful for pseudoarthrosis.
Thoracic mobile neurinoma
Authors: Namura Shobu , Hanakita Junya , Suwa Hideyuki , Mizuno Masaki , Ohtsuka Toshiyuki , Asahi Minoru
Published: May 2009

✓ The authors report a rare case of intraspinal thoracic mobile neurinoma in a 51-year-old man. The clinical symptoms, especially thoracoabdominal discomfort, changed remarkably according to the patient's posture. Magnetic resonance images demonstrated that the level of the caudal end of the tumor varied between T4–5 and T9–10 with changes in the patient's position. Intraoperative myelography was useful in identifying the tumor location and choosing the level of the laminectomy.
A spring-coil tipped cannula for anchoring cystic lesions during stereotactic aspiration
Authors: Arbit Ehud , Galicich Joseph H.
Published: May 2009

✓ A device to facilitate the stereotactic aspiration of cystic lesions is described. The device anchors the cyst wall, allows penetration of the lesion without displacement, and assures proper positioning of the tip of the aspiration needle within the cyst so that the contents may be evacuated without spillage.
Reflex variability in selective dorsal rhizotomy
Authors: Weiss Ira P. , Schiff Steven J.
Published: May 2009

✓ The variability of reflex responses during selective dorsal rhizotomy was studied in eight children between the ages of 3 and 7 years. For a given dorsal root or rootiet, the electrical reflex threshold and response varied considerably when observed over several minutes. Changes in electrode pressure, mechanical dissection of the root, and reflex spatial facilitation were all found to contribute to the variability. Even when electrode pressure was held constant, intrinsic spinal cord reflex variability substantially weakened the predictability of the intraoperative selection method used during this surgery.
Effect of mild hypothermia on uncontrollable intracranial hypertension after severe head injury
Authors: Shiozaki Tadahiko , Sugimoto Hisashi , Taneda Mamoru , Yoshida Hiroyoshi , Iwai Atsushi , Yoshioka Toshiharu , Sugimoto Tsuyoshi
Published: May 2009

✓ Recent experimental studies have demonstrated that mild hypothermia at about 34°C can be effective in the control of intracranial hypertension. A randomized controlled study of mild hypothermia was carried out in 33 severely head-injured patients. All patients fulfilled the following criteria: 1) persistent intracranial pressure (ICP) greater than 20 mm Hg despite fluid restriction, hyperventilation, and high-dose barbiturate therapy; 2) an ICP lower than the mean arterial blood pressure; and 3) a Glasgow Coma Scale score of 8 or less. The patients were divided into two groups: one received mild hypothermia (16 patients) and one served as a control group (17 patients).

Mild hypothermia significantly reduced the ICP and increased the cerebral perfusion pressure. Eight patients (50%) in the hypothermia group and three (18%) in the control group survived (p < 0.05), while five (31%) in the hypothermia group and 12 (71%) in the control group died of uncontrollable intracranial hypertension (p < 0.05). In five patients in the hypothermia group, cerebral blood flow was measured by the hydrogen clearance method and arteriojugular venous oxygen difference was evaluated before and during mild hypothermia. Mild hypothermia significantly decreased the cerebral blood flow, arteriojugular venous oxygen difference, and cerebral metabolic rate of oxygen (p < 0.01). The results of this preliminary investigation suggest that mild hypothermia is a safe and effective method to control traumatic intracranial hypertension and to improve mortality and morbidity rates.
Spinal cord infarction associated with primary antiphospholipid syndrome in a young child
Authors: Hasegawa Mitsuhiro , Yamashita Junkoh , Yamashima Tetsumori , Ikeda Kiyonobu , Fujishima Yoshie , Yamazaki Masahide
Published: May 2009

✓ Antiphospholipid antibodies have been reported to occur in ischemic stroke patients, but there have been no previous reports linking these antibodies to spinal cord infarction. A case of spinal cord infarction associated with primary antiphospholipid syndrome in a 6-year-old boy is reported. Magnetic resonance imaging clearly demonstrated marked swelling of the thoracolumbar spinal cord with gadolinium-diethylenetriamine pentaacetic acid enhancement at an acute stage, followed later by cord atrophy. Serological study disclosed positive lupus anticoagulant and immunoglobulin G anticardiolipin antibody. It is suggested that the role of antiphospholipid antibodies as an etiological factor for spinal cord ischemia should be recognized among causes that might have been categorized as either spontaneous spinal cord infarction or myelitis.
Pigmented villonodular synovitis of the spine
Authors: Clark Leo J. P. , McCormick Patrick W. , Domenico Don R. , Savory Lucy
Published: May 2009

✓ Pigmented villonodular synovitis commonly occurs in synovial joints of the appendicular skeleton, but rarely affects the synovial joints of the spine. It has both neoplastic and benign features, and the etiology is thought to be posttraumatic. The case of a young man presenting with paraparesis and a large thoracic lesion is reported.
A new brain retractor
Authors: Miyake Hiroji , Ohta Tomio
Published: May 2009

✓ A new brain retractor is presented that can be applied easily and safely from any direction. It is particularly useful in the evacuation of intracerebral hematomas.
Thyrotropin-producing pituitary adenomas
Authors: Mindermann Thomas , Wilson Charles B.
Published: May 2009

✓ To evaluate the biology of thyrotropin (TSH)-producing pituitary adenomas, the authors reviewed the charts of 19 patients who underwent transsphenoidal surgery within a 15-year period at the University of California, San Francisco (UCSF). Between 1989 and 1991, the period during which immunostaining techniques were used consistently for diagnosis, 2.8% of the pituitary adenomas treated at UCSF were TSH-producing. The rate of reoperation for tumor recurrence was 10.5%. Before pituitary surgery, more than one-third of the 19 patients had undergone thyroid ablation. Two patients had a history of Hashimoto's thyroiditis. The female:male ratio was 1.7:1. Women tended to develop these tumors at a younger age and had a longer history of symptoms but their tumors were smaller and less often invasive than those seen in men. About 50% of the tumors were purely TSH-producing and 50% were plurihormonal, including five that produced both TSH and adrenocorticotroph hormone. All tumors were macroadenomas. Before surgery, 46% of the patients had abnormal electrocardiographic findings; 16% had a rapid onset of severe neurological conditions either before or after surgery. It is concluded that TSH-producing adenomas are more common in patients who undergo surgical treatment than was previously thought. In addition, they occur more frequently in women, have a different biology in women than in men, and tend to be associated with potentially life-threatening cardiovascular and neurological complications.
Intrathecal baclofen down-regulates GABAB receptors in the rat substantia gelatinosa
Authors: Kroin Jeffrey S. , Bianchi Gregory D. , Penn Richard D.
Published: May 2009

✓ At present, it is not clear why drug tolerance develops in patients receiving intrathecal baclofen for the chronic treatment of spasticity of spinal origin. To investigate the mechanisms of tolerance to the gamma-aminobutyric acid (GABAB) agonist baclofen, rats were implanted with intrathecal catheters and continuously infused with either the drug or saline for 1, 3, or 7 days. The dose chosen, 1 µg/hr, initially caused profound hindlimb motor weakness, but by Day 7 the rats had adapted to the drug and exhibited only minimal motor impairment. The animals were sacrificed on Day 1, 3, or 7 and quantitative autoradiography was used to determine the binding density and affinity of the GABABreceptors in the substantia gelatinosa of the lumbar spinal cord. After I day of drug infusion there was no change in binding parameters, but after 3 and especially after 7 days there was a significant decrease in the GABABbinding density (74% and 66%, respectively) in baclofen-treated rats as compared to saline-treated control rats. This GABABreceptor down-regulation correlated with tolerance to the motor weakness in the baclofen-treated animals and suggests that similar mechanisms contribute to drug tolerance in patients.
Bilateral temporal bone encephaloceles after cranial irradiation
Authors: Lalwani Anil K. , Jackler Robert K. , Harsh Griffith R. , Butt Fidelia Yuan-Shin
Published: May 2009

✓ Irradiation of the central nervous system may cause significant morbidity, including endocrine dysfunction and intellectual impairment. The authors report a case of bilateral temporal bone encephaloceles in a 21-year-old man who had received prophylactic central nervous system irradiation for acute lymphocytic leukemia in early childhood. Endaural encephaloceles are uncommon, and most occur as a complication of mastoid surgery. The etiology, clinical features, radiological diagnosis, and surgical treatment of temporal bone encephaloceles are discussed.
Use of recombinant human erythropoietin to avoid blood transfusion in a Jehovah's Witness requiring hemispherectomy
Authors: Schiff Steven J. , Weinstein Steven L.
Published: May 2009

✓ The use of perioperative human recombinant erythropoietin is described in a Jehovah's Witness patient. Despite significant anemia, the child's hematocrit was sufficiently increased by the use of erythropoietin so that a two-stage hemispherectomy could be performed without blood transfusion.