bluuebunny/crossref_metadata_2025 huggingface dataset:
Intracerebral Hematoma: Spontaneous Cure by Drainage into the Middle Ear
Authors: Bose Bikash , Kraut William , Osterholm Jewell L.
Published: May 2010

A case of a spontaneous cure of intracerebral hematoma by drainage into the middle ear is reported. A 38-year-old man was brought to the emergency room in a semicomatose state. He was found to have skull fractures and an intracerebral hematoma. His clinical condition improved, and a repeat computed tomographic scan showed disappearance of the hematoma and its replacement by air.
Primary Intracranial Mesenchymal Chondrosarcoma
Authors: Kubota Toshihiko , Hayashi Minoru , Yamamoto Shinjiro
Published: May 2010

A case of a large intracranial mesenchymal chondrosarcoma with probable distant metastases to the humerus and the lung is presented. The pertinent literature is reviewed with respect to the presentation, treatment, and prognosis of this tumor. Total removal of the tumor is the treatment of choice. The prognosis is poor because of frequent recurrence and metastasis.
Early Angiographic Changes after Carotid Endarterectomy
Authors: Oiaz Fernando G. , Patel Suresh , Boulos Roushdy , Mehta Bharat , Ausman James I.
Published: May 2010

This report reviews the angiographic evaluation of 41 patients who underwent a carotid endarterectomy at Henry Ford Hospital. Postoperative angiograms were performed after 48 endarterectomies. Changes included the development of postoperative intimal flaps, common carotid stenosis, carotid occlusions, areas of corrugation, surface irregularities, and postendarterectomy dilatation. The development of dilatation, or the pantaloon effect, on the endarterectomized segment contributed to the limited use of angioplastic procedures. The benefits derived from a postoperative angiogram include the objective evaluation of the endarterectomized segment, the demonstration of a potentially complicating problem such as intimal flaps that could lead to restenosis, and recognition of the possible development of associated local problems. The procedure can be done with limited risks to the patients and in competent hands has low morbidity and mortality.
Asymptomatic Cerebral Aneurysm
Authors: Dell Stephen
Published: May 2010

In view of the widely divergent opinions regarding the necessity for operation in cases of asymptomatic and multiple cerebral aneurysms, an attempt is made to derive the true lifetime risk of rupture for a cerebral aneurysm in the asymptomatic patient. Prevalence data from autopsy and angiographic studies are utilized to derive a lifetime incidence for the rupture of such asymptomatic aneurysms. A decremental life table analysis method is used. The case of multiple asymptomatic aneurysms in a patient with another symptomatic aneurysm must be considered separately. Implications of these calculations are drawn regarding operation for unruptured or incidental aneurysms.
Furosemide in the Intraoperative Reduction of Intracranial Pressure in the Patient with Subarachnoid Hemorrhage
Authors: Samson Duke , Beyer Chester W.
Published: May 2010

The effect of furosemide in the intraoperative reduction of intracranial pressure was measured in 25 patients undergoing the operative repair of a ruptured intracranial aneurysm. Seven patients with similar intracranial lesions served as controls. A single bolus of 80 mg of furosemide was administered intravenously after the induction of anesthesia, and sequential measurements were made of intracranial pressure, mean arterial pressure, and arterial blood gases. A mean decrease of intracranial pressure of 56% was measured in the furosemide-treated patients, whereas the control patients demonstrated a mean decline of subarachnoid pressures of 18%. These changes are significant at the P < 0.005 confidence level, whereas changes in mean arterial pressure, mean arterial pCO2, and base line arterial pCO2 were statistically insignificant. This study suggests that intravenous furosemide is a quick, dependable, and effective mechanism for the intraoperative reduction of intracranial pressure in the postsubarachnoid hemorrhage aneurysm patient.
Sitting Prone Position for the Posterior Surgical Approach to the Spine and Posterior Fossa
Authors: Cook Albert W. , Siddiqi Tariq S. , Nidzgorski Florence , Clarke Hadley A.
Published: May 2010

The sitting prone position is compared with the standard laminectomy prone position and the sitting up position for posterior fossa surgery. We measured central venous pressure and airway pressure with the patient in different positions to determine the comparative efficacy of the sitting prone position. On a linear average, the central venous pressure increased by 6.83 cm H2O and the airway pressure increased by 3.16 cm H2O when the patient was changed from the supine to the standard prone position under general anesthesia; with a change from the standard prone position to the sitting prone position, the central venous pressure decreased by 10.45 cm H2O and the airway pressure decreased by 3.66 cm H2O. However, comparing the sitting prone position for posterior fossa surgery with the sitting up position, there was no statistically significant difference in central venous or airway pressure.
Thrombosed Vein of Galen Aneurysm
Authors: Olin Michael S. , Eltomey Atef A. , Dunsmore Rembrandt H. , Roberts Melville P.
Published: May 2010

The authors report a case of thrombosed vein of Galen aneurysm in a 4.5-year-old girl with craniofacial dysostosis (Crouzon's disease). Six previously reported cases appear in the literature. The initial presentation is often associated with the symptoms and signs of hydrocephalus. Computed tomography shows an enhancing mass in the region of the posterior 3rd ventricle with the characteristic “target sign.” Arteriography of all aspects of both the anterior and the posterior cerebral circulation is essential. Surgical results in cases of vein of Galen aneurysm have generally been poor, but recent reports of successful operative intervention to treat the thrombosed variety promise satisfactory treatment.
Periodic Alternating Gaze
Authors: Larmande Pierre , Henin Dominique , Jan Michel , Gouaze André
Published: May 2010

A clinicopathological study with electro-oculographic recording of a patient with periodic alternating gaze (PAG) is presented. There have been five previously reported anatomical observations of patients with this disorder. Bilateral cerebral disease with a mesencephalic lesion is observed. A study of oculovestibular reactions suggests that the generator of PAG is independent of the vestibular system
Seizures Due to Metrizamide Myelography in Patients with Acute Cervical Spine Injury
Authors: Conner Scott E. , Martuza Robert L. , Heros Roberto C.
Published: May 2010

Two patients each experienced a grand mal seizure after metrizamide myelography for acute cervical spine injury. Because of the potential disastrous consequences of a seizure in a patient with an unstable cervical spine, it is suggested that metrizamide be avoided in this setting whenever possible.
Prevention of Vasospasm by Early Operation with Removal of Subarachnoid Blood
Authors: Mizukami Masahiro , Kawase Takeshi , Usami Takashi , Tazawa Toshiaki
Published: May 2010

Sixty-four patients who were operated on within 4 days after acute subarachnoid hemorrhage are included in this study. All patients underwent preoperative computed tomographic (CT) scanning, and the amount and distribution of subarachnoid blood clot were noted. Operation was carried out by the frontobasal lateral approach, and the subarachnoid clot was removed by microsurgical suction-irrigation after clipping of the aneurysm. Immediate postoperative CT scanning was performed to evaluate the completeness of the subarachnoid blood clot removal. The presence or absence of postoperative vasospasm was determined with angiography performed between the 7th and 10th postoperative days. All patients were, of course, also evaluated for evidence of neurological deterioration. Approximately two-thirds of the patients in this series showed high density subarachnoid blood clot on the preoperative CT scan. The postoperative CT scans showed that it was possible to remove the majority of the blood clot except that located in the frontal interhemispheric fissure, the posterior part of the insular cistern on the approached side, and all of the insular cistern on the contralateral side. There was no spasm or only mild spasm in any site where the blood clot had been successfully removed. Delayed neurological deficits occurred only in those cases in which subarachnoid blood clot remained in the cisterns. These results suggest that it is possible to prevent intracranial arterial spasm and associated neurological deterioration by early operation and removal of clotted blood from the subarachnoid space.
Dermoid Cysts of the Anterior Fontanelle
Authors: Pannell Beverly W. , Hendrick E. Bruce , Hoffman Harold J. , Humphreys Robin P.
Published: May 2010

A review of the medical records at The Hospital for Sick Children in Toronto, Ontario, from 1967 through 1980 showed that, of the 94 cases of dermoid cyst of the skull treated at this institution by the neurosurgical staff, 25 were located over the anterior fontanelle. This is the largest single group of cases reported to date. The children were 2 months to 13 years of age, but two-thirds were treated before their 1st birthday. Females outnumbered males 2:1, and all of the patients presented with a nontender swelling over the anterior fontanelle, which had been present from birth. The lesions were treated by a variety of surgical approaches, all of which were curative. None of the lesions has recurred. The most interesting finding was that all but 2 of the children were white, in contrast to all previously published series. This confirms our belief that the racial incidence of dermoid cysts of the anterior fontanelle is a reflection of the general population. A review of previously published cases and the pathology and embryology of the lesion is included.
Intracerebral Chemotherapy
Authors: Kroin Jeffrey S. , Penn Richard D.
Published: May 2010

Cisplatin, a chemotherapeutic agent used to treat tumors in many parts of the body, does not reach brain tissue during systemic injection because of the blood-brain barrier and protein binding in the blood. To allow hydrophilic drugs, such as cisplatin, to reach brain neoplasms with minimal body toxicity, we tested chronic intracerebral microperfusion into the extracellular space of the brain in normal rats. Small stainless steel cannulas connected to osmotic minipumps were stereotactically placed in the midline cerebellum or frontal cortex, and cisplatin was pumped into the brain at the rate of 0.9 μg/hour for periods of up to 7 days. Brain tissue was then analyzed for the total platinum content, at 1-mm intervals from the cannula tip, using atomic absorption spectroscopy. The results of the animal studies show that a platinum concentration of 2 ng/mg of tissue, wet weight, can be maintained over a 1-cm region of brain. If all of the extracellular platinum has remained in the active cisplatin form, then this would be equivalent to a drug concentration of 10 μM. Cisplatin at this constant level has been shown to have a therapeutic effect against various tumor lines in vitro. To extend these results to human brain neoplasms, we estimate that one cannula would be sufficient to treat a 1-cm tumor or a larger tumor that could be surgically reduced. For inoperable tumors of up to 2 cm in diameter, a multiple cannula system would be required to yield the 10 μM concentration throughout. For larger inoperable tumors, local infusion will not produce high enough drug levels. In conclusion, chronic intracerebral microinfusion can be used to produce adequate and sustained therapeutic drug levels over a considerable region of tissue without the problem of systemic toxicity.
Revascularization of the Rostral Brain Stem
Authors: Hopkins L. N. , Budny James L. , Spetzler Robert F.
Published: May 2010

The clinical and angiographic diagnosis of rostral brain stem vascular insufficiency is reviewed. The various possibilities for surgical revascularization of this area include anastomosis of the superficial temporal or occipital artery to the main stem of the posterior cerebral or superior cerebellar artery or their branches. A new technique for anastomosing the superficial temporal artery to the posterior cerebral artery in the tentorial incisura is presented, and other methods of rostral brain stem revascularization are considered. Indications for revascularization of the rostral brain stem are not clearly defined, but should include clinical and angiographic evidence of upper brain stem ischemia.
Glossopharyngeal Neuralgia Associated with Syncope and Seizures
Authors: St. John James N.
Published: May 2010

A case of glossopharyngeal neuralgia associated with seizures, syncope, bradycardia, and hypotension is presented. Intracranial section of the 9th cranial nerve and the upper filaments of the 10th cranial nerve resulted in the resolution of all symptoms. The literature is reviewed and the pathogenesis and treatment of the condition are discussed.
Intraventricular Hematoma Secondary to a Ventriculoperitoneal Shunt
Authors: Kuwamura Keiichi , Kokunai Takashi
Published: May 2010

A rare and serious complication of a ventriculoperitoneal shunt is reported. A huge intraventricular hematoma was confirmed by computed tomographic scanning and autopsy. This is the first report of such a complication in a newborn with hydrocephalus.
Perioperative Management of High Risk Patients with Cardiopulmonary Disease Undergoing Carotid Endarterectomy or Extracranial-Intracranial Bypass
Authors: Pritz Michael B. , Kindt Glenn W.
Published: May 2010

Among a large group of patients who underwent either carotid endarterectomy or extracranial-intracranial (EC-IC) bypass were 13 patients who had cardiopulmonary monitoring performed by a dye dilution technique either with or without a thermodilution Swan-Ganz catheter. Each patient had at least two significant medical problems that were thought to place him or her at increased risk. The usefulness of this monitoring approach in the perioperative management of these patients is demonstrated by several clinical examples. No patient sustained myocardial infarction, congestive heart failure, or new neurological deficit during the perioperative period. Our experience suggests that high risk patients can safely undergo either carotid endarterectomy or EC-IC bypass provided that careful attention is paid to myocardial function and the state of hydration.
Cortical Nicotinamide Adenine Dinucleotide (NADH) Kinetics in Patients Undergoing Extracranial-Intracranial Bypass
Authors: Fein Jack M. , Olinger Rodney
Published: May 2010

Nicotinamide adenine dinucleotide (NADH) kinetics were measured in 76 cortical areas in 26 patients with transient ischemic attacks (TIAs) undergoing extracranial-intracranial bypass. Direct cortical stimulation was utilized to induce changes in surface fluorescence corresponding to a brief oxidation and reduction of mitochondrial NADH. Preoperative studies of cerebral blood flow in gray matter ((CBF)g) demonstrated normal perfusion in 11 patients and ischemic changes ((CBF)g < 43.5 ml/100 g/minute) in 15 patients. In 30 normally perfused areas within the craniotomy, the mean half-time for reduction (t½(red)) of cortical NAD was 21.5 ± 2.6 seconds. In 39 ischemic areas, the mean t½(red) was 5.6 ± 1.2 seconds. These rapid reduction rates were associated with supernormal overshoots of the base line indicative of a transient oxygen debt. Kinetic responses could not be elicited from 7 areas adjacent to foci of decreased attenuation on computed tomography. Bypass resulted in normalization of the t½(red) in 24 of 28 areas of ischemia. The dependence of NADH kinetics on blood flow through the graft was demonstrated in 15 of 19 areas of mild ischemia by the reapplication of a clip to the donor artery. It is concluded that persistent reversible abnormalities of cortical mitochondrial metabolism exist in a significant number of patients with a history of TIAs who are suitable candidates for bypass surgery. In such patients bypass may effectively augment the nutrient supply to meet the bioenergetic demands associated with increased electrophysiological activity.
Effect of Age and Reoperation on Survival in the Combined Modality Treatment of Malignant Astrocytoma
Authors: Salcman Michael , Kaplan Richard S. , Ducker Thomas B. , Abdo Hatem , Montgomery Elizabeth
Published: May 2010

Before the advent of the operating microscope and the carbon dioxide laser, reoperations were performed in less than 5% of patients with malignant astrocytoma. Between 1978 and 1981, a consecutive series of 74 adult patients were prospectively treated with operation, radiation, and 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) chemotherapy. After the failure of primary therapy, all patients eligible for further treatment were offered reoperation with the microscope and/or laser before treatment with Phase I agents (microwave hyperthermia, dimethyl sulfoxide (DMSO)-Adriamycin, DMSO-Cytoxan, or azaridinylbenzoquinone (AZQ)). Forty-six per cent of the patients were referred from outside institutions for intensive treatment. In 36 months, 40 patients received second operations directed at their tumor and had a median calculated survival from the time of reoperation of 37 weeks. The length of survival after the second operation was independent of patient age, performance status, tumor grade, and interoperative interval. Sixty-five per cent of patients under 40 and 48% of patients over 40 underwent reoperation with minimal morbidity and no deaths. The single most important prognostic factor for survival in both reoperated and single-operated patients was age. Tumor grade had no influence on survival in the series as a whole, in patients under 40 years of age, or in reoperated patients. The calculated median survival for the entire series was 15 months, with a predicted 2-year survival rate of 0.25. These figures include all patients treated without exclusion for incomplete radiotherapy or chemotherapy. It is concluded that reoperation for malignant astrocytoma is safe, feasible, and of potential benefit in combination with other therapies. The routine use of reoperation to “set up” other treatment modalities deserves further study.
Use of the Carbon Dioxide Laser in the Operative Management of Intracranial Meningiomas
Authors: Strait Timothy A. , Robertson Jon H. , Clark Craig W.
Published: May 2010

This study presents 20 cases of meningioma of various intracranial locations, all of which were removed with the carbon dioxide surgical laser system. The carbon dioxide laser is contrasted with other means of meningioma removal to emphasize the advantages of this new technology. These advantages include: (Neurosurgery) the ability to operate with smaller exposures, (Neurosurgery) reduced brain retraction, (Neurosurgery) a reduced amount of mechanical manipulation by vaporizing the tumor mass, (Neurosurgery) vaporization of the dural attachment after the removal of tumor, (Neurosurgery) improved operative precision, and (Neurosurgery) decreased intraoperative blood loss. The authors think that this new technology in combination with the operating microscope represents a significant advancement in the ability to remove meningiomas that might prove difficult to extirpate by conventional means.
Lumbar Monoradiculopathy Due to Unilateral Facet Hypertrophy
Authors: Reynolds Arden F. , Weinstein Philip R. , Wachter Richard D.
Published: May 2010

Twenty-two patients presented during the last 3 years with unilateral symptoms and signs of a lumbar monoradiculopathy indistinguishable from those of a disc herniation. All had compression of the nerve root posteriorly by a hypertrophic facet without anterior compression from the disc. None of the patients had spinal claudication. Preoperative evaluation with computed tomographic (CT) scanning was disappointing as the pathology was correctly defined in only 1 of 10 patients. Lumbar myelography was helpful, but did not always localize the lesion. The decision to operate was based primarily on the clinical grounds of persistent or progressive radiculopathy. The operative techniques used were two-level hemilaminectomy in 7 patients, single level laminectomy in 4, and multilevel laminectomy in 11. Surgical exploration revealed that the site of compression ranged from the medical canal to the lateral recess. The root was compressed by inferior facets 8 times and by superior facets 14 times. Back pain was relieved in 12 of 15 patients, and leg pain was relieved in 19 of 21. Neurological deficit was relieved in 19 and improved in 3. It is concluded that standard CT and myelographic techniques may not anatomically define the point of radicular compression. Intraoperatively the root must be explored from its dural origin to a point beyond the pedicle to ensure adequate decompression. Most, but not all patients with hypertrophic radicular compression will improve after surgical decompression.
Delayed Epidural Hematoma Demonstrated by Computed Tomography
Authors: Rappaport Z. Harry , Shaked Itzchak , Tadmor Rina
Published: May 2010

A case of delayed visualization of an acute parietal epidural hematoma by computed tomography (CT) in a child is presented. The initial CT 2½ hours after injury was negative. After neurological deterioration, a repeat CT scan 8 hours postinjury demonstrated a parietal epidural hematoma and a small cerebellar hematoma. The case demonstrates the need for a high level of vigilance in head trauma patients even in the face of an initially negative CT scan.
Oculomotor Nerve Anastomosis
Authors: Iwabuchi Takashi , Suzuki Mikio , Nakaoka Tsutomu , Suzuki Shigeharu
Published: May 2010

We report a patient who underwent anastomosis of the left oculomotor nerve, which had been inadvertently and bluntly severed during the resection of a left parasellar chromophobe pituitary adenoma. Neural regeneration was confirmed by the reappearance of voluntary adduction of the eyeball, clinical signs of aberrant regeneration, and the appearance of an action potential on electromyography of the levator palpebrae superioris muscle 1 year after end-to-end anastomosis of the nerve.
Acute Cerebrospinal Fluid Hydrothorax
Authors: Davidson R. I. , Zito J.
Published: May 2010

A 3½-year-old child with a bilateral chronic subdural hematoma due to battering suffered a recurrence on one side. She was treated successfully with a subdural-pleural shunt. Two months later, she returned with severe respiratory embarrassment due to what we think was a cerebrospinal fluid hydrothorax. The maintenance of her earlier neurological recovery was confirmed, and her hydrothorax was cured by removing the shunt. No hydrocephalus ensued.
Ischemic Complications after Combined Internal Carotid Artery Occlusion and Extracranial-Intracranial Anastomosis
Authors: Diaz Fernando G. , Ausman James I. , Pearce Jeffrey E.
Published: May 2010

Seven of 120 aneurysm patients admitted to the Henry Ford Hospital from October 1978 to August 1981 had giant internal carotid artery aneurysms that were treated by a combined internal carotid artery occlusion and extracranial-intracranial anastomosis. Three of these patients developed postoperative ischemic complications during the progressive closure of the carotid artery. These complications included the transient onset of syncope, hemiparesis, hemisensory deficits, and dysphasia. These complications resolved after the clamp was reopened and/or intravenous heparin was given. The possible mechanisms involved in the development of ischemia included the development of emboli at the occlusion site or inadequate flow originating from the area of the anastomosis. Prolonged occlusion of the vessel over a 7- to 10-day course with concurrent administration of intravenous heparin is recommended.
Impaired Immunocompetence in Patients with Malignant Gliomas
Authors: Gerosa Massimo A. , Olivi Alessandro , Rosenblum Mark L. , Semenzato Gian Piero , Pezzutto Antonio
Published: May 2010

T-lymphocyte subpopulations (Tg or “suppressor cells” and Tm or “helper cells”) in the peripheral blood of 16 patients with malignant intracranial gliomas were analyzed. The number of Tm-lymphocytes was very close to normal in both preand postoperative samples, whereas Tg-lymphocytes were significantly increased preoperatively (18.55 ± 1.11 vs. 12.72 ± 1.19, p < 0.001) and were still slightly higher than normal after operation and radiation treatment. These preliminary findings suggest a possible role of T-suppressor lymphocytes in the impairment of cell-mediated immunocompetence that has been observed repeatedly in patients with malignant gliomas.
Calculation of Stereotactic Coordinates from the Computed Tomographic Scan
Authors: Gildenberg Philip L. , Kaufman Howard H. , Murthy K. S. Krishna
Published: May 2010

A protocol has been developed to use the GE 8800 scanner and its resident programs to calculate stereotactic coordinates. which has made it possible to use any stereotactic apparatus without modifying the apparatus in order to introduce a cannula into any lesion visualized on a computed tomographic (CT) scan to biopsy tumors. drain abscesses. implant radioisotopes. etc. The CT scanning is done in a routine fashion except that a lateral ScoutView. with the planes of each CT slice indicated, is included. Once the CT scan has been completed, resident programs for measuring distances are used to establish a zero point on a reference plane, from which all other coordinates can be defined. The stereotactic procedure is done at a separate time in the operating room, using the coordinates derived from the CT scan. The ScoutView image is compared to the lateral x-ray film taken during the stereotactic procedure to establish the location of the targets. It has been estimated that the accuracy of this system is 3 mm. Abscesses less than 1 cm in diameter deep within the cerebral hemisphere have been accurately aspirated and tumor biopsies have been successfully taken.
Ventricular Catheter in the Cistern of the Transverse Fissure
Authors: Masdeu Joseph C. , Chuman Charles M.
Published: May 2010

We report a case of shunt malfunction despite a working flushing device and free cerebrospinal fluid flow from the ventricular catheter. The ventricular end of the catheter had been placed in the cistern of the transverse fissure.
Rupture of a Previously Unruptured Giant Middle Cerebral Artery Aneurysm after Extracranial-Intracranial Bypass Surgery
Authors: Scott R. Michael , Liu Hsiu-Chih , Yuan Robert , Adelman Lester
Published: May 2010

The fatal rupture of a previously unruptured giant middle cerebral artery aneurysm occurred 13 days after an extracranial-intracranial bypass had been carried out, before definitive aneurysm surgery. Alterations in blood flow adjacent to the aneurysm after the bypass may have led to the fatal hemorrhage. After a preliminary extracranial-intracranial bypass procedure, there should be no undue delay in the direct attack on a giant aneurysm, regardless of its mode of presentation.
Hypoglossal Neurilemoma
Authors: Berger Mitchel S. , Edwards Michael S. B. , Bingham W. George
Published: May 2010

The case of a patient harboring a rare intracranial hypoglossal nerve sheath tumor is presented, and the literature concerning this lesion, especially with relation to age and sex patterns and the initial and presenting symptoms and signs, is reviewed. The importance of a thorough radiological examination with detailed vertebral angiography and contrast-enhanced computed tomographic scans of the hypoglossal canal is discussed. Based on our experience with this patient, we recommend total excision of this lesion.
Spinal Subdural Metastatic Adenocarcinoma
Authors: Hirsh Leonard F. , Thanki Ashok S. , Spector Harvey B.
Published: May 2010

Metastatic spinal cancer is common and usually involves the bony spine or the epidural space. We are reporting a case of breast carcinoma metastatic to the spinal subdural space, and we review the literature concerning this unusual metastatic site. Unlikely metastatic locations should be suspected whenever myelography in cancer patients with spinal cord signs is confusing.
Ruptured Anterior Spinal Artery Aneurysm
Authors: Moore Daniel W. , Hunt William E. , Zimmerman Eric J.
Published: May 2010

A case of aneurysm at the junction of the vertebrospinal and anterior spinal arteries at the level of C-1 is presented. There was severe intracranial subarachnoid hemorrhage with subsequent right hemiplegia and 6th nerve palsies. Angiograms showed an anomalous arrangement of the arteries, but no arteriovenous malformation was seen. The lesion was repaired via a posterior approach. Anatomical and technical considerations of this approach are discussed. A review of the pertinent literature is presented.
Simple Decompression and Occasional Microsurgical Epineurolysis under Local Anesthesia as Treatment for Ulnar Neuropathy at the Elbow
Authors: Lavyne Michael H. , Bell William O.
Published: May 2010

Decompression of the ulnar nerve in the cubital tunnel will reverse ulnar neuropathy at the elbow in most patients. We believe that operating under local anesthesia has allowed us to identify those few patients who will not respond to simple decompressive surgery. Among the 20 cases of ulnar neuropathy managed in this fashion, intraoperative motor-sensory improvement occurred after simple decompressive surgery in 16. Four patients who failed to improve after cubital tunnel decompression underwent microsurgical epineurolysis immediately thereafter, under the same local anesthetic, with prompt improvement. Local anesthesia and microsurgical epineurolysis seem to be useful adjuncts to simple decompressive surgery for ulnar neuropathy.
Symptomatic Large Parietal Foramina
Authors: Pang Dachling , Lin Angela
Published: May 2010

A mother and her two children with large parietal foramina were studied with plain roentgenograms and computed tomography. The mother's comments convinced us that the bilateral defects in the children evolved from a single midline opening via median ossification. The children had recurrent bouts of unexplained headaches and vomiting. Gentle pressure over the defects and combing of the overlying hair produced local pain and violent headaches in all three patients. These characteristic symptoms as well as other clinical problems associated with this anomaly are discussed.
Neurofibroma of the Infratemporal Fossa: Case Report and Technical Note
Authors: Rengachary Setti S. , McMahon Michael , Bigongiari Lawrence R. , Ketcherside Joseph , Gunter Kurt
Published: May 2010

The authors present a case of benign neurofibroma arising from the infratemporal fossa, which they removed successfully through a transoral transmaxillary approach. The anatomy of the infratemporal region is discussed. The transoral transmaxillary approach and the parotid approach to the infratemporal fossa are contrasted.
Supratentorial Subarachnoid Epithelial Cyst: Case Report and Ultrastructural Study
Authors: Pearl Gary S. , Takei Yoshio , Tindall George T. , Hoffman James C.
Published: May 2010

Supratentorial epithelial cysts are rare entities that have evoked controversy regarding their pathogenesis. Recent ultrastructural studies have failed to resolve this controversy. We present a case report and an ultrastructural study of such a cyst. The cyst wall was lined by columnar epithelial cells with prominent cilia and microvilli at their apical surface. They were joined by well-developed junctional complexes and contained abundant intracytoplasmic, electron-dense, granular material. some of which was membrane-bound. These ultrastructural findings suggest that epithelial cysts are derived from elements of the embryological tela choroidea.
Hemianopia: A Presenting Feature of Acute Epidural Hematomas
Authors: Matwijecky Cornelius , Steinbok Paul
Published: May 2010

Visual field abnormalities were studied in a retrospective analysis of 199 patients with epidural hematomas. One hundred three patients had been alert enough at the time of hospital admission to have had their visual fields examined, but in only 27 patients were visual fields documented in the charts. Six of the 27 patients (22%) had a correctly localizing homonymous hemianopia. The case histories of these 6 patients are detailed and the pathogenetic mechanisms of the visual field abnormalities are discussed. The importance of recognizing that homonymous hemianopia can be an early sign of an epidural hematoma is stressed.
Mega Cisterna Magna: Diagnosis Using Metrizamide Computed Tomographic Cisternography
Authors: Hough Douglas R. , Mengel Mark B. , Malik Ayaz H.
Published: May 2010

The mega cisterna magna is one cause of a midline, extra-axial, posterior fossa cyst. The computed tomographic features and differential diagnosis of midline posterior fossa cystic structures are reviewed, and the clinical features of the mega cisterna magna are discussed. We describe a method of metrizamide cisternography and report a case of mega cisterna magna that was diagnosed by this technique.
Giant Cell Tumor of the Skull: A Report of Two Cases
Authors: Epstein Nancy , Whelan Margaret , Reed Deborah , Aleksic Slobodan
Published: May 2010

Giant cell tumor of the skull is an extremely rare clinical entity. We describe two patients with this neoplasm and review the pertinent literature relating to its biology, treatment, and prognosis.
Successful Evacuation of Subdural Hematoma in the Presence of Severe Coagulopathy
Authors: Winston Ken , Conner Scott
Published: May 2010

An acute subdural hematoma was evacuated in the presence of a severe coagulopathy that was probably due to disseminated intravascular coagulation. A satisfactory result was achieved.
Tension Pneumocephalus after Surgical Treatment of Chronic Subdural Hematoma: Report of Three Cases
Authors: Bremer Alfonso M. , Nguyen Tai Q.
Published: May 2010

This report illustrates three cases of symptomatic tension pneumocephalus developing after evacuation of chronic subdural hematoma (SDH) by burr holes. Review of the literature revealed that tension pneumocephalus is seldom recognized as a reason for neurological deterioration after the surgical treatment of chronic SDH.
Hemodynamic Effects of N2O, O2 Barbiturate Anesthesia and Induced Hypotension in Early versus Late Aneurysm Clipping
Authors: Sokoll M. D. , Kassell N. F. , Gergis S. D.
Published: May 2010

The cardiovascular effects of large dose thiopental anesthesia and induced hypotension were examined in 22 patients undergoing clipping of ruptured intracranial aneurysms. Eleven patients operated on within 4 days of the initial bleed (early group) were compared with those operated on more than 10 days after the bleed (late group). Systemic and pulmonary arterial pressures, central venous pressure, and cardiac output were measured. The cardiac index and the systemic and pulmonary vascular resistance were calculated. Before the induction of anesthesia, the cardiac index was 4.00 ± 0.3 litres/minute/m2 in the early group compared with 2.89 ± 0.23 litres/minute/m2 in the late group (P < 0.05). Five and 10 minutes after the administration of mannitol (1 g/kg) and at an induced hypotensive level of 60 torr, the cardiac index remained significantly higher in the early group (P < 0.05). There was no significant difference in the mean arterial blood pressure between the groups. Systemic vascular resistance was significantly higher in the late group during the postinduction and the pre-mannitol infusion periods and at induced hypotensive levels of 50 and 40 torr. Central venous pressure was significantly higher in the early group only at the preanesthesia (control) measurement. There was no significant difference between the groups in the pulmonary artery wedge pressure or the pulmonary vascular resistance.
Subarachnoid Enhancement Secondary to Subarachnoid Hemorrhage with Special Reference to the Clinical Significance and Pathogenesis
Authors: Hirata Yoshifumi , Matsukado Yasuhiko , Fukumura Akinobu
Published: May 2010

Contrast-enhanced computed tomographic scans of 30 patients with acute subarachnoid hemorrhage due to ruptured intracranial aneurysm were analyzed in relation to subarachnoid enhancement and clinical features. In 15 cases, subarachnoid enhancement was noted either early or late during the clinical progress of subarachnoid hemorrhage. In the positive group, hydrocephalus and cerebral infarction due to vasospasm frequently accompanied enhancement during the early stage of subarachnoid hemorrhage. The diffuse type of subarachnoid enhancement was most valuable for predicting cerebral infarction due to vasospasm. The authors review the literature on the pathogenesis of subarachnoid enhancement.
Clinical Toxicity of Combined Modality Treatment with Nitrosourea Derivatives for Central Nervous System Tumors
Authors: della Cuna Gioacchino Robustelli , Paoletti Pietro , Bernardo Giovanni , Knerich Roberto , Butti Giorgio , Cuzzoni Quinto
Published: May 2010

Two nitrosourea compounds— 1,3-bis(2-chloroethy1)-1-nitrosourea (BCNU) and 1-(2-chloroethy1)-3-cyclohexyl-1-nitro-sourea (CCNU)—have been used in the treatment of primary and metastatic brain tumors after operation and/or radiotherapy. Hematological and nonhematological toxicity were recorded in 272 patients treated between May 1973 and June 1978. BCNU was given to 135 patients (80 mg/m2 i.v. daily for 3 days) and CCNU was given to 137 patients (130 mg/m2 orally, single dose) every 8 weeks until progression of the primary disease process or for a total of 12 cycles. Radiation therapy (5500 ± 500 rads in 6 to 7 weeks) was carried out after the first course of chemotherapy. BCNU and CCNU induced the same hematological and clinical toxicity. The bone marrow toxicity seemed to be dose-related, delayed, and cumulative. One case of acute nonlymphoblastic leukemia arising 2 months after the end of CCNU therapy is reported.
Early Management of Aneurysmal Subarachnoid Hemorrhage
Authors: Ljunggren Bengt , Brandt Lennart , Sundbärg Göran , Säveland Hans , Cronqvist Sten , Stridbeck Hans
Published: May 2010

The Lund Clinic serves a population of 1.46 million inhabitants. During the calendar year 1981, 72 patients presented with a ruptured supratentorial aneurysm, diagnosed either at angiography or at autopsy. Upon admission, 60% of the patients were in good condition and 40% were in poor condition. Eighty-three per cent were admitted within 72 hours after the subarachnoid hemorrhage (SAH). In the total series, 50% made a good recovery; the overall management morbidity was 19%, and the management mortality was 31%. Thirty-one patients in Grades I–III underwent early operation (43% of the total series), with a favorable outcome in 74% and 7% mortality. Of the 35 patients who were admitted early and in good condition, 71% made a good recovery, and the management mortality was 9%. These figures may be compared to the 51% favorable outcome and 27% mortality reported from the Cooperative Aneurysm Study with late operation. In the early operation cases, the incidence of significant arterial narrowing at postoperative angiography performed on Day 9 ± 2 after SAH was 30% and the incidence of permanent neurological deficits of delayed onset was 10%. Two of the early operation patients developed permanent symptomatic hydrocephalus.
Penetrating Spinal Injury by a Glass Fragment: Case Report and Review
Authors: Baghai Parviz , Sheptak Peter E.
Published: May 2010

Stab wounds of the spinal canal are rare. Usually they produce obvious neurological deficits, but occasionally patients present with cerebrospinal fluid leak or related symptoms. We report a case of penetration of the lumbar dural sac with a glass fragment. Postural headache and mild back pain were the only presenting complaints. The radiological findings, surgical indications, and management are discussed, and a review of the literature is presented.
Evolving Role of Digital Subtraction Angiography in Neurosurgical Practice
Authors: Duff Thomas A. , Turski Patrick A. , Sackett Joseph F. , Strother Charles M. , Crummy Andrew B.
Published: May 2010

Advances in digital subtraction angiography (DSA) have allowed the evaluation of a number of pathological conditions involving the extra-and intracranial vasculature. In addition to its role in diagnosis. DSA has been used for the postoperative assessment of endarterectomy, aneurysm clipping, and vascular bypass and for the follow-up of arteriovenous fistulas or malformations. This paper describes the theory and anticipated improvements in the digital processing of radiological information and presents our initial assessment of its clinical utility.
Origin and Properties of Spinal Cord Field Potentials
Authors: Yates Billy J. , Thompson Floyd J. , Mickle Parker J.
Published: May 2010

Electrical or natural stimulation of cutaneous, muscle, or visceral nerves evokes a field potential in the spinal cord; the field potential elicited by each type of afferent fiber differs in wave form. Cutaneous nerve-evoked spinal cord field potentials consist of a triphasic spike, one to three negative waves, and a slow positive wave. Muscle nerve-evoked spinal cord field potentials are composed of a triphasic spike, a slow positive wave, and one to three negative waves with different relative latencies and durations than the negative waves evoked by cutaneous nerves. Visceral nerve-evoked potentials in the spinal cord comprise only a single negative wave and a slow positive wave. The triphasic spike is a compound action potential propagating through the large primary afferent fibers; the negative waves are generated by dorsal horn interneurons; the positive wave is a reflection of primary afferent depolarization. A knowledge of the origin and properties of spinal cord field potentials has practical usefulness for both the experimental neurophysiologist and the clinician.
Computed Tomography-guided Intracranial Biopsy and Cyst Aspiration
Authors: Greenblatt Samuel H. , Rayport Mark , Savolaine Edward R. , Harris James H. , Hitchins Mark W.
Published: May 2010

A coordinated series of instruments has been developed for use in computed tomography (CT)-guided brain lesion biopsy and cyst aspiration: a plastic guide needle that is relatively free of CT artifacts, a ball-and-socket holding device for multidirectional sampling, and an aspiration-cutting biopsy needle that reliably produces consistent cores of tissue. Twenty-six biopsy and/or aspiration procedures have been performed on 24 patients with an overall biopsy success rate of 79%. The method is most reliable with highly malignant astrocytomas and least reliable with metastases and unusual primary tumors. There were 3 complications: 2 intratumoral hematomas and 1 death due to hemorrhage. A survey of published CT biopsy series shows an overall success rate of 85%. The rate of serious complications is 3.5% (including 3 deaths). The incidence of intratumoral hematomas that are clinically silent or associated with relatively minor clinical problems is 9%. CT-guided intracranial biopsy is more reliable than the earlier freehand methods and simpler than stereotactic techniques. It is the procedure of choice for percutaneous biopsy of superficial and deep hemispheric lesions.
Changes in the Visual Evoked Potentials of Hydrocephalic Children
Authors: Guthkelch Norman A. , Sclabassi Robert J. , Vries John K.
Published: May 2010

The visual evoked potentials (VEPs) of a group of 84 hydrocephalic children, aged between 2 days and 15 years, were studied. The variables analyzed were age, ventriculomegaly, head size, and the presence or absence of a functioning shunt. In infants, an increase in the latency of the primary positive wave (P2) was confirmed, but this was present consistently only when ventriculomegaly was accompanied by increased head size. Improvement in the VEP was slow to follow shunting. No change in the latency of P2 was found during hydrocephalic episodes in older children.
Successful Treatment of the Normal Perfusion Pressure Breakthrough Syndrome
Authors: Day Arthur L. , Friedman William A. , Sypert George W. , Mickle Parker J.
Published: May 2010

Massive, multifocal bleeding after the technically successful removal of a cerebral arteriovenous malformation (AVM) represents a frightening and usually catastrophic complication. This phenomenon, termed normal perfusion pressure breakthrough by Spetzler et al., is caused by the diversion of blood flow from the AVM into adjacent, maximally dilated, and nonautoregulating small vessels. We recently encountered three cases of cerebral AVM that exhibited breakthrough bleeding immediately after an apparently successful operation. In all cases, the surgeon was unable to control the resultant hemorrhage by standard microsurgical techniques. High dose barbiturate anesthesia, combined with blood pressure reduction to the lower levels of the normal cerebral perfusion curve, was then initiated in each case. Controlled hyperventilation, steroids, and osmotic dehydrating agents were also used to control intracranial pressure elevation. After maintenance of this regimen for several days, the patients were returned to the operating room for hematoma evacuation. At this time, bleeding was controlled easily and breakthrough did not occur. Although this regimen requires intensive anesthetic, pulmonary, and cerebral monitoring, it successfully salvaged all three patients. Two made immediate, remarkable recoveries, and the third patient is slowly improving. This protocol therefore seems promising for the management of the massive, uncontrollable cerebral swelling or bleeding that may occur as a consequence of AVM removal.
Microsurgery of the Fourth Ventricle: Part 1
Authors: Matsushima Toshio , Rhoton Albert L. , Lenkey Carla
Published: May 2010

Operations on the 4th ventricle offer the potential for injury of the brain stem, cerebellum, cranial nerves, and major cerebellar arteries and veins. Twenty-five cadaver brains were examined using 3× to 25× magnification to define the relationship of these vital structures to the 4th ventricle. The 4th ventricle has a roof, a floor, and two lateral recesses. Most of the cranial nerves arise near the floor, which sits on the pons and medulla. The superior half of the roof, formed by the superior medullary velum, lingula, and cerebellar peduncles, is intimately related to the cerebellomesencephalic fissure, the superior cerebellar arteries, and the vein of the cerebellomesencephalic fissure. The inferior half of the roof, formed by the inferior medullary velum, tela choroidea, nodule, and uvula, is intimately related to the cerebellomedullary fissure, the posterior inferior cerebellar arteries, and the veins of the cerebellomedullary fissure. The lateral recesses and adjoining parts of the roof and floor are intimately related to the cerebellopontine fissures, the anterior inferior cerebellar arteries, and the veins of the cerebellopontine fissure. The cerebellar peduncles converge on and form a major part of the ventricular surface. The hili of the dentate nuclei abut on the superolateral recesses of the ventricle near the superior poles of the tonsils.
Nontraumatic Subdural Hematoma Secondary to Dural Metastasis: Case Report and Review of the Literature
Authors: Turner Donn M. , Graf Carl J.
Published: May 2010

A case of nontraumatic subdural hematoma secondary to dural metastasis from endometrial adenocarcinoma is presented. The presumed mechanism of production and occurrence of this unusual complication from an unusual central nervous system metastasis is reviewed briefly.
Extreme Pseudo-occlusion of the Internal Carotid Artery
Authors: Yonas Howard , Meyer John
Published: May 2010

Angiographic criteria for the identification of patients with angiographic internal carotid artery occlusion but with anatomical patency are presented. The presence of retained contrast material in a caudal atherosclerotic internal carotid artery stump, especially when accompanied by visualization of the internal carotid artery at the base of the skull, suggests that the internal carotid artery may be patent. Two cases of “extreme” pseudo-occlusion are presented, and the indications for extracranial-intracranial bypass and caudal internal carotid artery stump resection are reviewed.