bluuebunny/crossref_metadata_2025 huggingface dataset:
Intramedullary Fibrosarcoma of the Cervicomedullary Junction: A Case Report
Authors: Rappaport Harry Z. , Constantini Shlomi , Sigal Tali , Shuger Lucia
Published: May 2010

A 17-year-old girl presented with signs of increased intracranial pressure. On computed tomography, an enhancing intraaxial lesion in the region of the foramen magnum was demonstrated. Surgical excision was performed. The pathological diagnosis was low grade fibrosarcoma. Her subsequent course was complicated by cerebrospinal fluid seeding, a posterior fossa recurrence, and repeated subarachnoid hemorrhage with cerebral vasospasm. A combination of radiotherapy and intraventricular chemotherapy has left the patient symptom-free 2 years after operation. The intramedullary appearance of fibrosarcoma and the unusual subsequent clinical course are discussed. (Neurosurgery 21:551-553, 1987)
Idiopathic Massive Osteolysis of Skull Bones: A Case Report
Authors: Rao Ranga S. V. , Reddy Raja D. , Reddy Madhav G. , Reddy Kantha P. , Mohan U. L. , Reddy Mohan
Published: May 2010

A rare case of idiopathic massive osteolysis involving cranial bone is reported. Radiological and computed tomographic findings are discussed, along with a brief review of the literature. (Neurosurgery 21:564-566, 1987)
Cervical Carotid Artery Dissection Secondary to Malignant Fibrous Histiocytoma
Authors: Kaplan Barry J. , Day Arthur L.
Published: May 2010

A rare case of malignant fibrous histiocytoma of the cervical carotid artery is presented. Erosion of the vessel wall by this neoplasm resulted in dissection and pseudoaneurysm formation. The etiology and diagnosis of and the therapeutic alternatives for this unique disorder are discussed briefly. (Neurosurgery 21:571-574, 1987)
Ganglioglioma of the Cerebellum: Case Report
Authors: Mizuno Junichi , Nishio Shunji , Barrow Daniel L. , Davis Patricia C. , Tindall George T.
Published: May 2010

The authors report a rare case of a cerebellar ganglioglioma. A review of 12 previously reported cases and our case suggest that surgical removal of this neoplasm carries a good prognosis.
Proposal for Bipolar Coagulation of the Sella Turcica Wall during Pituitary Tumor Operation
Authors: Levy Walter J.
Published: May 2010

Convoluted morphology, limited visualization, and the lack of appropriate instruments limit the surgical approach to the walls of the sella turcica. They are, however, a site of local invasion and retained tumor fragments in cases of pituitary lesions. Effective bipolar coagulation within the sella turcica could reduce recurrence from local invasion, but it is made difficult because rigid bipolar forceps cannot fit effectively or safely against the complex contours of the walls there. Effective coagulation and thorough tumor removal are further frustrated by the lack of direct visualization of either the sella walls or the part of the floor adjacent to the surgical opening. It would be desirable, however, to coagulate the dura mater and retained tumor fragments. As an aid in this problem, we are reporting the use of a flexible bipolar coagulation system in two forms and of a mirror system for visualization in the sella without requiring the removal of one hand from surgical maneuvers. A pair of parallel flexible wire extensions to the standard bipolar forceps can be shaped by the surgeon into a contour that will coagulate the specific local terrain. A web of wire woven into one surface of a cotton patty, which is a bipolar coagulation system, supplements the wire loops. This allows the walls of the sella turcica to be coagulated more effectively where the contours are difficult to gauge and not well visualized. For visualization of the sella turcica walls and floor, we have used a small front surface mirror 1.0 mm thick. With a small suction-cotton patty placed behind the mirror, the mirrior can be used to dry fields or those with a mild ooze. It provides good visualization of the sellar walls when focused on by an operating microscope. In 11 cases, this system was an aid in control of bleeding and allowed coagulation of the sella walls. Furthermore, it has allowed identification of persistent tumor fragments on the sella wall in 3 cases. These fragments were then removed, and their attachment was coagulated. This capability may allow identification and coagulation of tumor that cannot be reached currently. If these sites are so treated, recurrence rates may be reduced significantly.
Reoperation for Recurrent Glioblastoma and Anaplastic Astrocytoma
Authors: Harsh Griffith R. , Levin Victor A. , Gutin Philip H. , Seager Margaret , Silver Pamela , Wilson Charles B.
Published: May 2010

The advisability of a second operation for recurrent glioblastoma multiforme or anaplastic astrocytoma depends on the expected duration and quality of subsequent survival. We reviewed the results in 70 consecutive patients who underwent reoperation for supratentorial glioblastoma multiforme (n = 39) or anaplastic astrocytoma (n = 31) between 1975 and 1984. The operative morbidity rate was 5.7% (4 of 70 patients); the 6-week postoperative mortality rate was 4.3% (3 of 70 patients). The median duration of survival after reoperation was 36 weeks in patients with glioblastoma multiforme and 88 weeks in those with anaplastic astrocytoma. The median duration of high quality survival (defined as the period during which the patient had a Karnofsky performance score of at least 70) after reoperation was 10 weeks for patients with glioblastoma multiforme and 83 weeks for patients with anaplastic astrocytoma. Age and preoperative Karnofsky score in patients with glioblastoma multiforme and age in patients with anaplastic astrocytoma had statistically significant effects on the duration of high quality survival after reoperation, but not on postoperative survival independent of quality. Although age and functional status do not significantly affect the duration of survival after reoperation, they do have a significant effect on the quality of life after reoperation. Frequently, a patient can expect to spend a greater portion of his life at a higher level of function than he would have without reoperation. As adjunctive forms of therapy improve, reoperation will play an increasingly prominent role in the management of recurrent malignant astrocytic tumors. (Neurosurgery 21:615-621, 1987)
Diagnostic Potential of Magnetic Resonance in Cases of Foramen Magnum Meningiomas
Authors: Wagle V. G. , Melanson D. , Ethier R. , Bertrand G. , Feindel W.
Published: May 2010

Meningioma is a histologically benign tumor that is second in frequency only to gliomas among primary intracranial tumors. Its extracerebral development and generally clear demarcation from the brain does not make it easier to detect on magnetic resonance (MR) scanning. Only 2 to 3% of meningiomas occur in the foramen magnum, and these tumors are often clinically misdiagnosed. We discuss four cases of foramen magnum meningioma, with emphasis on MR scanning.
Neuropsychological Function in Patients after Subarachnoid Hemorrhage
Authors: Bornstein R. A. , Weir B. K. A. , Petruk K. C. , Disney L. B.
Published: May 2010

Neuropsychological testing of 48 patients who had undergone operation for subarachnoid hemorrhage (SAH) due to aneurysm was performed. Before this, the patients had their level of neurological recovery classified by neurosurgeons (37 good outcome vs. 9 poor outcome). These clinical categories correlated well with the results of neuropsychological testing. The degree of psychological impairment was related to age. The mean duration between SAH and clipping of the ruptured aneurysm was 4.6 days (range, 1-16 days), and 59% had operations on or before Day 3 post-SAH. Of the 37 patients with good neurological outcome, 26 patients had good neuropsychological outcome (no more than mild deficit). Poor neuropsychological outcome was associated with age and anterior communicating artery aneurysms. The incidence of significant neuropsychological deficit was considerably less than in previous reports, and possible explanations are discussed.
Spontaneous Subarachnoid Hemorrhage in Young Adults
Authors: Biller José , Toffol Gilbert J. , Kassell Neal F. , Adams Harold P. , Beck David W. , Boarini David J.
Published: May 2010

We evaluated 95 hospitalized patients (50 women and 45 men) aged 15 to 45 who had nontraumatic subarachnoid hemorrhage (SAH). Aneurysmal SAH was identified in 75 patients. Other causes for SAH were ruptured arteriovenous malformations (2 cases), amphetamine arteritis (1 case), and leptomeningeal melanoma (1 case). The cause of SAH was undetermined in 16 (17%) patients. Thirteen patients had histories of hypertension, 5 used oral contraceptives, and 4 had consumed large quantities of alcohol during the day before SAH. Only 1 patient had Type I diabetes mellitus. Diagnosis was delayed in 21 patients. Operation was performed in 71 patients, with only 3 (4.2%) deaths. The overall mortality was 8.4% (8 of 95), with all deaths due to neurological causes. Our data suggest that the overall management and surgical results of treatment of ruptured aneurysms in young adults are excellent, diabetes is rare among young adults with SAH, recent alcohol consumption does not seem to be a major factor predisposing to SAH in young adults, and misinterpretation of the early symptoms of SAH continues to be a serious problem. (Neurosurgery 21:664-667, 1987)
Alterations in Primary and Coupled Neck Motions after Facetectomy
Authors: Raynor Richard B. , Moskovich Ronald , Zidel Paul , Pugh James
Published: May 2010

Normal neck motion is a complicated phenomenon. A primary motion results from an applied force or torque. Secondary coupled motions also result as a consequence of the primary motion. These resulting coupled motions were measured in isolated cervical motion segments using three-dimensional videophotogrammetry with a coordinate system fixed in space. A cross coupling algorithm provided error correction and conversion from local to true cartesian coordinates. The data were analyzed by computer, and the true coupled motions resulting from any applied force were obtained. A second group of specimens was facetectomized, and the experiments were repeated. After facetectomy, a moment about the anteroposterior axis resulted in marked reduction in lateral displacement, decrease in vertical displacement, and decrease in rotation about the vertical axis. Results were significant at P < 0.01 and represent a significant decrease in coupled motions resulting from lateral bending. At P < 0.05, a laterally applied force causes less lateral displacement and lateral flexion, but more longitudinal displacement. Flexion and extension movements are not significantly altered after facetectomy. (Neurosurgery 21:681-687, 1987)
Intracranial Pressure in Head-injured Patients with Various Intracranial Lesions Is Identical throughout the Supratentorial Intracranial Compartment
Authors: Yano Masami , Ikeda Yukio , Kobayashi Shiro , Otsuka Toshibumi
Published: May 2010

Subarachnoid pressure was measured by bifrontal catheterization to obtain concurrent comparative intracranial pressures (ICPs). These ICPs were compared in 15 head-injured patients who had differences in the pathological processes affecting the right and left hemispheres. ICPs in these patients ranged from -3 to 130 mm Hg, but no difference was found in the concurrent comparative ICPs. These findings suggest that the supratentorial space can generally be considered as one compartment regardless of the differences in types of intracranial lesions. (Neurosurgery 21:688-692, 1985)
Unilateral Exophthalmos Caused by an Invasive Pituitary Adenoma
Authors: Daita Go , Yonemasu Yukichi , Hashizume Akira
Published: May 2010

A case of pituitary adenoma associated with unilateral exophthalmos is reported. An intraorbital infiltrative tumor growth was verified by histopathological study. The mechanism of exophthalmos is discussed, and edema of the intraorbital tissue secondary to an inflammatory reaction or venous stasis associated with tumor cell infiltration is considered to be the cause of exophthalmos in this patient. (Neurosurgery 21:716-718, 1987)
Intraspinal Tumors Associated with Hydrocephalus
Authors: Kudo Hiroshi , Tamaki Norihiko , Kim Shigekuni , Shirataki Kunio , Matsumoto Satoshi
Published: May 2010

Three cases of intraspinal tumors associated with hydrocephalus were encountered and treated. This review includes 67 cases, including these 3 cases, and discusses the pitfalls associated with intraspinal tumors presenting with hydrocephalus. These tumors are not easily diagnosed, especially in cases where the chief complaint, due to hydrocephalus, is headache or dementia, and does not include back pain. Among the 67 cases reviewed, symptoms suggesting normal pressure hydrocephalus were particularly noticed in patients over 40 years old. In cases presenting with headaches or dementia, back pain corresponding to the tumor location may appear after a shunt operation or external ventricular drainage. This postoperative back pain is important in indicating the presence of an intraspinal tumor.
The Abducted Arm as a Sign of Ruptured Cervical Disc
Authors: Beatty Robert M. , Fowler Fred D. , Hanson Jerome E.
Published: May 2010

A helpful clinical sign of ruptured cervical disc is pain relief upon arm abduction. When the disease process is spondylosis with foraminal stenosis, changing arm position does not relieve pain. Anatomical considerations are discussed. (Neurosurgery 21:731-732, 1987)
Down-Beat Nystagmus: Case Report with Magnetic Resonance Imaging and Surgical Treatment
Authors: Pinel Jean François , Larmande Pierre , Guegan Yvon , Iba-Zizen Marie Thérèse
Published: May 2010

A woman with down-beat nystagmus (DBN) underwent magnetic resonance imaging (MRI), which showed a syringo-myelic cyst in the medulla. Surgical treatment of the cyst ended the abnormal eye movement. This case demonstrates the use of MRI for the diagnosis of DBN. It also shows the value of surgical treatment when a cyst is responsible for this symptom, as in Arnold-Chiari malformation. (Neurosurgery 21:736-739, 1987)
Cerebrospinal Rhinorrhea in a Patient with a Posterior Cranial Fossa Tumor
Authors: Benvenuti Dino , Lavano Angelo , Corriero Giuseppe , Irace Claudio , de Divitiis Enrico
Published: May 2010

A rare case of a meningioma of the posterior margin of the petrous temporal bone associated with cerebrospinal fluid rhinorrhea is presented. After a careful review of the literature, the possible pathogenesis of the fistulous tract is discussed. (Neurosurgery 21:742-744, 1987)
Fusiform Aneurysm of Basilar Artery and Ectatic Internal Carotid Arteries Associated with Glycogenosis Type 2 (Pompe's Disease)
Authors: Braunsdorf W. E.
Published: May 2010

A case of a proven glycogenosis Type 2 (Pompe's disease) with a fusiform aneurysm of the basilar artery associated with ectatic internal carotic arteries and multiple intracerebral embolisms is presented. (Neurosurgery 21:748-749, 1987)
Serum Melatonin Levels: A New Neurodiagnostic Tool in Pineal Region Tumors?
Authors: Vorkapic Peter , Waldhauser Franz , Bruckner Robert , Biegelmayer Christian , Schmidbauer Manfred , Pendl Gerhard
Published: May 2010

The pineal hormone melatonin (MLT) is secreted in a circadian rhythm with high serum levels during nighttime and low serum levels during daytime. Several authors have reported an altered secretion pattern of MLT in patients with pineal tumors and have proposed that MLT may be used as a tumor marker. In nine patients, a pineal region tumor was diagnosed by computer-assisted tomography. Before and after surgical removal of the tumor, several day- and nighttime serum samples were collected and MLT concentrations were estimated by radioimmunoassay. Before operation, five patients presented a normal circadian pattern of MLT secretion. In the remaining four subjects, MLT levels were undetectable or at the limit of detection, with no signs of a circadian secretion pattern. Eight patients were reexamined after tumor resection, when all but one had undetectable or very low MLT levels. The remaining subject, with a pineomesencephalic pilocytic astrocytoma, dislocating but not involving the pineal gland, presented a normal circadian secretion pattern of MLT after operation; in this case, tumor resection was possible without damaging the pineal gland. Thus, before operation, MLT deficiency rather than exaggerated serum levels may be used as a marker for pineal tumors that destroy the pineal gland. After tumor resection, serum MLT may serve to demonstrate complete pinealectomy.
Hemispheric Disconnection Syndrome Persisting after Anterior Cerebral Artery Aneurysm Rupture
Authors: Levin Harvey S. , Goldstein Felicia C. , Ghostine Salim Y. , Weiner Richard L. , Crofford Marsha J. , Eisenberg Howard M.
Published: May 2010

Hemispheric disconnection syndrome is a rarely reported sequela of aneurysm rupture. Serial neurobehavioral examinations of such a patient after clipping of a right pericallosal artery that had bled into a large portion of the corpus callosum disclosed defects in interhemispheric transfer of information and competitive movements between the left and right extremities. Although the patient's postoperative memory deficit subsequently resolved, his disconnection syndrome persisted and was primarily responsible for his disability despite otherwise normal neurological findings. We studied a second patient with a hematoma in the genu of the corpus callosum secondary to an arteriovenous malformation (AVM). Although the second patient also exhibited postoperative memory problems, her hemispheric disconnection symptoms were minimal and commensurate with a more circumscribed corpus callosum lesion. Neurobehavioral sequelae of aneurysm or AVM rupture involving the anterior circulation, which may be overlooked in the absence of a detailed examination, can produce persistent disability in many patients.
Treatment of Chronic Pain by Deep Brain Stimulation: Long Term Follow-up and Review of the Literature
Authors: Levy Robert M. , Lamb Sharon , Adams John E.
Published: May 2010

Since the senior author's (J.E.A.) first report in 1972 of the use of deep brain stimulation (DBS) to control chronic pain, electrodes for DBS have been implanted in 141 patients. Of reported series, this one has the largest number of patients and the longest period of follow-up. The mean age of patients in this study was 51.2 years. The mean length of follow-up was 80 months. Patients had experienced pain for a mean period of 65 months before DBS was attempted; all patients had exhausted other medical and surgical therapies. For the purposes of this study, pain states were characterized as being either nociceptive or deafferentation in nature. Nociceptive pain was treated primarily by stimulation of the periaqueductal or periventricular gray, and deafferentation pain was treated primarily by stimulation of the sensory thalamus. Eighty-four patients were treated for deafferentation pain, which included the thalamic pain syndrome (25 cases), peripheral neuropathic pain (16 cases), anesthesia dolorosa (12 cases), paraplegia pain (11 cases), postcordotomy dyesthesia (5 cases), phantom limb pain (5 cases), thoracic neuralgia (4 cases), and miscellaneous pain states (6 cases). We treated 57 patients with nociceptive pain states. 51 for low back and skeletal pain and 6 for pain from the invasion of cancer. Initial relief of pain was obtained by 83 patients (59%). After the mean follow-up period of 80 months, 42 patients (31%) continued to obtain significant pain relief with DBS. Some pain states, particularly anesthesia dolorosa and paraplegia pain, did not seem to respond to DBS. Major complications of therapy included wound infection (12%) and intracranial hemorrhage (3.5%); there was one death in the series (0.7%). Erosion of hardware occurred in 10 patients (7%), and foreign body reaction occurred in 7 (5%). Technical problems most often encountered included migration of the implanted electrodes and equipment failure that led to leakage of current and ineffective stimulation. These complications have been largely eradicated by advances in the design and manufacture of hardware over the 14 years of the study. A review of studies in which long term follow-up of patients treated with DBS was reported, including this series, suggests that lasting relief of pain is obtained in 47% and 60% of patients with deafferentation and nociceptive pain, respectively. Thus, in a carefully selected and evaluated group of patients, DBS can be an effective treatment for chronic, intractable pain.
Results of Combined Surgical and Medical Therapy in Patients with Prolactin-secreting Pituitary Macroadenomas
Authors: Candrina Renato , Galli Giuseppe , Bollati Angelo , Pizzocolo Giuseppe , Orlandini Alberto , Gualandi Franco G. , Giustina Gianni
Published: May 2010

To assess the long term effectiveness of combined sequential surgical and medical therapy in the management of prolactin-secreting pituitary macroadenomas, we followed 21 patients for 46 ± 6 months (mean ± SE) after diagnosis (range, 12 to 96 months). All patients underwent operation. Six were also treated with bromocriptine, 7.5 mg/day immediately after operation. A group of 15 patients with tumor sizes similar to those of the first group was followed without medical therapy until signs of regrowth of the neoplasia were evident. No patient of the combined therapy group experienced a recurrence of the disease. On the other hand, only 2 patients of the second group were recurrence-free at the end of follow-up. In the other 13 cases, adjunctive therapy had to be established for clinical and radiological evidence of tumor recurrence 26 ± 7 months after operation. We conclude that combined sequential surgical and medical therapy may be useful in the management of macroprolactinomas. Our hypothesis must be confirmed by studies that compare patients treated with operation plus bromocriptine with patients treated with bromocriptine alone.
Intraradicular Herniation of a Lumbar Disc: A Case Report
Authors: Ergüngör Fikret M. , Kars Zafer H.
Published: May 2010

The authors report an unusual case of intraradicular lumbar disc herniation. A large fragment of lumbar disc was found within the sheath of the right S1 nerve root. Surgical treatment results in a satisfactory clinical outcome. The literature on intradural and intraradicular lumbar disc herniation is reviewed.
Intraoperative Anaphylaxis after Irrigation with Bacitracin: Case Report
Authors: Netland Peter A. , Baumgartner James E. , Andrews Brian T.
Published: May 2010

We report a case of anaphylaxis caused by irrigation with a bacitracin solution during lumbar laminectomy. The patient had been exposed to bacitracin during a previous anterior cervical discectomy. We recommend avoiding the use of irrigation solutions containing bacitracin in patients with previous systemic exposure to this antibiotic.
Peritumoral and Intratumoral Hemorrhage after Gelatin Sponge Embolization of Malignant Meningioma: Case Report
Authors: Suyama Tohru , Tamaki Norihiko , Fujiwara Kiyoshi , Hamano Seiji , Kimura Mitsuru , Matsumoto Satoshi
Published: May 2010

The authors report a case of peritumoral and intratumoral hemorrhage during therapeutic embolization with gelatin sponge powder for malignant meningioma. One should be wary of this severe, unexpected complication when performing preoperative embolization.
Suspension Laminotomy: A New Surgical Technique for Compression Myelopathy
Authors: Ohmori Kazuo , Ishida Yoshihiro , Suzuki Kazuhiro
Published: May 2010

In an attempt to eliminate the many negative aspects of conventional extensive laminectomy, we originated in 1981 and have developed a new surgical technique called “suspension laminotomy.” A basic principle of this operation is preservation and repair of the soft and bony tissue of the spine with osseous enlargement of the spinal canal. Eighty-one patients were treated with suspension laminotomy. This operative technique can be applied to almost all segments of the spine and can be used for all cases that would usually have been treated with conventional extensive laminectomy. We emphasize the necessity of repairing paraspinal muscles and discuss the postoperative spinal deformities and the dural constriction, which seemed to be caused by scar formation after conventional laminectomy. Suspension laminotomy should minimize the negative aspects of conventional extensive laminectomy.
Subtemporal Transdural Use of Detachable Balloons for Traumatic Carotid-Cavernous Fistulas
Authors: Batjer H. Hunt , Purdy Phillip D. , Neiman Melissa , Samson Duke S.
Published: May 2010

Endovascular use of detachable balloons has revolutionized the management of carotid-cavernous fistulas so that the goals of angiographic elimination of fistula and preservation of carotid patency can usually be achieved nonsurgically. Certain circumstances of flow dynamics and anatomy, however, make an endovascular approach difficult for even an experienced interventional neuroradiologist. Fistulas involving the posterior carotid wall at its proximal cavernous entry and the anterior carotid wall in its initial horizontal intracavernous segment, as well as very low flow fistulas at other sites, have posed particular problems. Three patients with such traumatic fistulas whose endovascular treatment failed were managed by the direct transdural introduction of balloons. Intraoperative angiography was accomplished with open internal carotid artery (ICA) catheterization and the use of a portable C-arm with a 6-in, image intensifier. After temporal craniectomy and subtemporal exposure, the course of the cavernous ICA was mapped out with spinal needles and the site of the fistula was localized by intraoperative angiography. An incision was then made in the lateral wall of the cavernous sinus, and latex balloons were manually introduced via a 7 French introducer sheath. The balloons were inflated under angiographic control and detached when the fistula was obliterated. This simple technique was initially successful in three patients; the fistula was eliminated with preservation of carotid patency. One patient suffered a recurrence of his fistula 2 months postoperatively while lifting weights, and one patient developed a new 3rd nerve palsy after operation. (Neurosurgery 22:290-296, 1988)
Central Spinal Cord Injury: Magnetic Resonance Imaging Confirmation and Operative Considerations
Authors: Fox John L. , Wener Louis , Drennan Dale C. , Manz Herbert J. , Won Daniel J. , Al-Mefty Ossama
Published: May 2010

A case of central cervical spinal cord injury, confirmed by magnetic resonance imaging (MRI) and treated by myelotomy, is presented. After recovering well from his central cord syndrome and walking with assistance, the patient developed a rapidly progressive myelopathy beginning 2 months after injury. His main injury localized clinically to the C8, T1 level; but central cord abnormalities were identified 3 months after injury at the C6 level by MRI: a high signal intensity on the proton density sequence and a low-signal intensity on the T1-weighted sequence. At operation 4½; months after his injury and 1 month after complete paraplegia, a myelotomy at C6 failed to reveal any cavity (syrinx) but instead disclosed only intense gliosis inside a slightly atrophic spinal cord. Rapid clinical improvement ensued. Secondary syringomyelia may be an endstage condition after spinal cord insults that trigger a progressive, pathophysiological reaction leading to central cord necrosis. In selected cases, myelotomy may interrupt this MRI-identified, nosogenic process before cavitation has occurred. (Neurosurgery 22:340-347, 1988)
Serious Complications of Microvascular Decompression Operations for Trigeminal Neuralgia and Hemifacial Spasm
Authors: Hanakita Junya , Kondo Akinori
Published: May 2010

Serious complications of microvascular decompression operations for trigeminal neuralgia or hemifacial spasm are reported. Among 278 patients who underwent microvascular decompression, 9 serious complications were observed: 1 intracerebellar hematoma with acute hydrocephalus, 1 cerebellar swelling with acute hydrocephalus, 1 supratentorial acute subdural hematoma, 2 status epilepticus, 1 infarction of the brain stem, 1 subarachnoid hemorrhage due to traumatic aneurysm, and 1 infarction in the territory of the posterior cerebral artery. Of the 9 patients with such complications, 2 died. The possible causes of such serious complications are discussed. (Neurosurgery 22:348-352, 1988)
Use of Perioperative Steroids with Microvascular Decompression Operations
Authors: Marion Donald W. , Jannetta Peter J.
Published: May 2010

Complications associated with the use of perioperative steroids in elective craniotomies were evaluated in a single-blind prospective study of 222 consecutive microvascular decompression operations. Patients were randomized into one of three groups: Group A received steroids preoperatively and for 4 days postoperatively, Group B received steroids preand postoperatively for 1 day, and Group C received no steroids. There were 17 complications in Group A; 12 of these were wound-related. There were significantly fewer complications in Groups B and C (P < 0.01). Group B had 3 complications, Group C had 4, and there was only 1 wound-related complication in Group C. There were no deaths, deep wound infections, or life-threatening complications. Severe postoperative headaches, a symptom that steroids were intended to minimize, occurred in 38% of patients in Group A, 42% of patients in Group B, and 25% of patients in Group C. The use of perioperative steroids did not reduce the length of postoperative hospitalization. Duration of the operation had no significant effect on the incidence of postoperative complications or the length of postoperative hospitalization. We conclude that there is no indication for the routine perioperative use of steroids with microvascular decompression operations of the posterior fossa cranial nerves and that such use leads to a higher incidence of postoperative complications. (Neurosurgery 22:353-357, 1988)
Predictive Value of Temporary External Lumbar Drainage in Normal Pressure Hydrocephalus
Authors: Haan Joost , Thomeer Raphael T.W.M.
Published: May 2010

In a prospective study on the effect of shunting, 22 patients diagnosed as suffering from normal pressure hydrocephalus (NPH) were investigated by means of temporary external lumbar drainage (ELD). Five patients had to be excluded from the study because of complications of ELD or definitive shunting. ELD correctly predicted the outcome of shunting in all of the remaining 17 patients. The value of external lumbar drainage in NPH is discussed on the basis of personal experience and data from the literature. It seems to be a safe and valuable tool for predicting the outcome of definitive shunting procedures. (Neurosurgery 22:388-391, 1988)
Traumatic Intracranial Aneurysms in Childhood: Two Cases and a Review of the Literature
Authors: Buckingham Martin J. , Crone Kerry R. , Ball William S. , Tomsick Thomas A. , Berger Thomas S. , Tew John M.
Published: May 2010

Traumatic intracranial aneurysms in childhood are rare. To date, 67 well-documented cases in children have been reported. We present 2 additional cases and review the literature. Traumatic aneurysms can best be categorized based on mechanism of injury and location. Aneurysms secondary to penetrating trauma occur most commonly in teenage boys suffering gunshot wounds. Aneurysms secondary to nonpenetrating trauma occur at the skull base or in the periphery, with motor vehicle accidents and falls as the most common modes of injury. Skull base traumatic aneurysms most commonly involve the petrous, cavernous, or supraclinoid carotid artery and also show a predominance in teenage boys. Peripheral traumatic aneurysms can further be divided into distal anterior cerebral artery aneurysms secondary to trauma against the falcine edge and distal cortical artery aneurysms associated with an overlying skull fracture. Peripheral traumatic aneurysms tend to occur in younger patients with a less marked male predominance. Two-thirds of the patients suffered symptomatic aneurysmal hemorrhage, with an associated mortality rate of 31%. The clinical presentation, diagnosis, and treatment of traumatic intracranial aneurysms are discussed. (Neurosurgery 22:398-408, 1988)
Relationships among Cortical Ischemia, Infarction, and Hemorrhage in Eclampsia
Authors: Salerni Anthony , Wald Steven , Flanagan Martin
Published: May 2010

Cerebral infarction and hemorrhage are well-known cerebrovascular complications of eclampsia. A 30-year-old woman with eclampsia developed bilateral posterior parietal and occipital hemorrhages 4 hours after computed tomography demonstrated lucencies indicative of ischemia or infarction within the same regions. The association between infarction and hemorrhage has not been previously documented by computed tomography in eclampsia. Review of the pathophysiological mechanisms and associated risk factors has prompted a more aggressive prophylactic therapeutic approach. (Neurosurgery 22:408-410, 1988)
Pleomorphic Xanthoastrocytoma: Report of Two Cases
Authors: Stuart Gordon , Appleton D.B. , Cooke Robin
Published: May 2010

Two cases of pleomorphic xanthoastrocytoma are presented to draw attention to this relatively benign variant of glioma. The circumscribed tumors, each with a cystic component, were located superficially, one in the mesial right temporal lobe and one in the right temporoparietal region. The patients were aged 12 and 14 years, and it is now almost 7 years since the onset of symptoms in the 12-year-old boy. The optimal plan of management is discussed. (Neurosurgery 22:422-427, 1988)
Technical Note: The Removal of Free Peritoneal Catheters in the Revision of Ventriculoperitoneal Shunts
Authors: Pomeranz Shlomo , Rapapport Harry Z. , Umansky Felix , Shalit Mordechai N.
Published: May 2010

The widespread usage of ventriculoperitoneal shunts has been followed by a plethora of complications. One of these complications, the separation and migration of the distal tubing to be free intraperitoneally, has been relatively disregarded in the literature both as a phenomenon and as to treatment. We present our experience with nine such cases, four involving two peritoneal catheters. Unless contraindicated, we think that such tubing should be removed during shunt revision by single digit blind palpation of the tubing. No complications arose from this procedure, and the postoperative course was uneventful. The indications for this procedure are discussed in relation to the relevant literature. (Neurosurgery 22:436-438, 1988)
Linear Accelerator as a Neurosurgical Tool for Stereotactic Radiosurgery
Authors: Winston Ken R. , Lutz Wendell
Published: May 2010

A new system has been developed for stereotactically delivering prescribed high doses of radiation to precisely located volumes of approximately 0.6 to 10.0 ml within the brain. A Brown-Roberts-Wells stereotactic apparatus and a 6-MeV linear accelerator equipped with a special collimator (12.5 to 30 mm in diameter) have been adapted. The 20-mm collimator allows treatment of a nearly spherical volume of 2.1 ml. Outside the treatment field, the dosage declines to 80% of the dose prescribed for the periphery of the lesion over a distance of 1.8 mm and to 50% over the next 3.4 mm. Localization can be accomplished via computed tomography or cerebral angiography. Treatment is accomplished with an arcing beam of photon radiation with the turntable (couch) in each of four positions. The entire system has been extensively tested for accuracy in alignment and distribution of radiation. Errors have been measured for the alignment of the apparatus and for the process of localization. Safety of operation was emphasized throughout the design and testing phase. (Neurosurgery 22:454-464, 1988)
Local Control of Recurrent Clival and Sacral Chordoma after Interstitial Irradiation with Iodine-125: New Techniques for Treatment of Recurrent or Unresectable Chordomas
Authors: Kumar Pradeep P. , Good Roger R. , Skultety F. Miles , Leibrock Lyal G.
Published: May 2010

Using new 125I brachytherapy techniques, we were able to deliver safely a tumor volume dose of 16,000 rads to a previous irradiated, large, recurrent sacral chordoma by means of the intraoperative interstitial implantation of 229 low activity 125I seeds and 40,000 rads to a previously irradiated, small, recurrent clival chordoma by means of the transnasal needle implantation of two high activity 125I seeds. Iodine-125 brachytherapy was followed by regression of tumor, lessening of symptoms, and bony recalcification in both cases. (Neurosurgery 22:479-483, 1988)
Controlled Study of Nimodipine in Aneurysm Patients Treated Early after Subarachnoid Hemorrhage
Authors: Mee Edward , Dorrance Deborah , Lowe Derek , Neil-Dwyer Glenn
Published: May 2010

We enrolled 75 consecutive patients admitted with subarachnoid hemorrhages in a randomized, double-blind, placebo-controlled trial to determine the effect of early intervention with nimodipine on outcome and cerebral blood flow. The cardioprotective effect of nimodipine was assessed by measuring the electrocardiographic changes over the first 3 days of drug treatment. There was a mild lowering of the mean cerebral blood flow in the nimodipine-treated group over the 21-day period. Analysis of the continuous electrocardiographic traces showed no difference between the nimodipine and placebo groups in the frequency or type of abnormality detected. At 3 months, 4 of the 38 patients receiving nimodipine had died, compared with 10 of the 37 placebo-receiving patients. Of the 50 eligible patients who had a proven cerebral aneurysm, 1 patient (4%) on nimodipine died compared with 6 (24%) receiving placebo (0.01 < P > 0.05, x2 test; approximate 95% confidence interval for mortality difference, 0.4% to 39.6%). We conclude that nimodipine does not increase the cerebral blood flow or protect the heart after a subarachnoid hemorrhage. There were no side effects from nimodipine. The trend toward improved outcome should be verified in a larger series of patients. (Neurosurgery 22:484-491, 1988)
Cerebrovascular Disorders Associated with von Recklinghausen's Neurofibromatosis: A Case Report
Authors: Sobata Eiji , Ohkuma Hiroki , Suzuki Shigeharu
Published: May 2010

A 28-year-old woman with von Recklinghausen's neurofibromatosis (NF-1) had a huge hematoma in the left posterior nuchal region. Carotid and vertebral angiograms revealed marked stenosis at the C3 portion of the left internal carotid artery, slight moyamoya staining, occlusion of the left vertebral artery at the atlas level, and a right internal carotid artery aneurysm. The radiographic, clinical, and histological features of this case are discussed together with a review of 42 similar cases found in the literature. (Neurosurgery 22:544-549, 1988)
Transvenous Balloon Occlusion of the Cavernous Sinus: An Alternative Therapeutic Choice for Recurrent Traumatic Carotid-Cavernous Fistulas
Authors: Shimizu Takeo , Waga Shiro , Kojima Tadashi , Tanaka Kimito
Published: May 2010

We report a case of traumatic carotid-cavernous fistula (CCF) that recurred some 9 years after carotid trapping. The recurrent CCF was accompanied by a huge aneurysmal dilatation of the cavernous sinus. Transarterial balloon occlusion of the proximal internal carotid artery failed to occlude the fistula completely because of collateral flow to the fistula. The fistula was completely occluded by a transvenous approach via the jugular vein and inferior petrosal sinus using detachable balloons. The transjugular-inferior petrosal approach to the cavernous sinus can be an alternative for the treatment of traumatic CCF when the transarterial approach has failed to occlude the cavernous sinus. (Neurosurgery 22:550-553, 1988)
Unusual Type of Spinal Arteriovenous Malformation
Authors: Aminoff Michael J. , Gutin Philip H. , Norman David
Published: May 2010

We describe an uncommon type of spinal arteriovenous malformation that is intradural rather than dural and that consists of a true fistula rather than a nidus of abnormal vessels between the anterior spinal artery and a draining vein. Its clinical significance and treatment are discussed. (Neurosurgery 22:589-591, 1988)
Slit Ventricle Syndrome Presenting with Paroxysmal Hypersomnia in an Adult: Case Report
Authors: Korfali Ender , Aksoy Kaya , Safi Imran
Published: May 2010

The slit ventricle syndrome (SVS), defined as intermittent shunt malfunction without substantial ventricular enlargement, is usually observed in shunted children with small, slitlike ventricles. This syndrome has been attributed to recurrent obstruction of the ventricular catheter, which then causes an increase of intracranial pressure. Only rarely has the SVS been reported in adults. We describe a 29-year-old woman whose shunt malfunction presented with longlasting paroxysmal hypersomnia and was diagnosed with computed tomographic evidence of small lateral ventricles. This episodic hypersomnia presented every 2 to 3 weeks and each episode lasted 1 to 2 weeks. After revision of the ventricular catheter, her symptoms stopped and she remained well. (Neurosurgery 22:594-595, 1988)
Synovial Cysts of the Spine
Authors: Onofrio Burton M. , Mih Alexander D.
Published: May 2010

A series of 13 patients with synovial or ganglion cysts of the spinal facet joints causing nerve root compression is reported. These cysts were found in both the cervical and the lumbar spine, and the anatomical location of each cyst corresponded to the patient's signs and symptoms. In no case was there evidence of intervertebral disc abnormality found at operation. The patients ranged from 49 to 77 years of age and included 4 men and 9 women. Radiographic evidence of facet degenerative change and degenerative spondylolisthesis was frequently but not invariably noted. The extradural defects defined with positive contrast myelography or postmyelography computed tomographic scanning were usually posterior or posterolateral to the common dural sac and were misinterpreted as extruded discs in the majority of cases. Treatment consisted of laminectomy and surgical excision of cysts. All patients reported improvement or resolution of their presenting symptoms.
The Critical First Minutes after Subarachnoid Hemorrhage
Authors: Grote Ernst , Hassler Werner
Published: May 2010

Six patients were observed during recurrent subarachnoid hemorrhage (SAH). Three each had an open skull and intact dura mater and demonstrated an extreme increase in intracranial pressure (ICP) that developed within 1 minute and then declined over several minutes. Three other patients were investigated with transcranial Doppler sonography before, during, and after recurrent bleeding, and their hemodynamics were studied. There is conclusive evidence that acute spontaneous SAH is often followed by an intracranial circulatory arrest lasting for several minutes and caused by a peak of ICP in the range of mean arterial levels. The mechanisms involved are discussed. There are strong indications that this temporary intracranial circulatory arrest promotes hemostasis, but may constitute a severe ischemic event.
Carotid Endarterectomy in Symptomatic Elderly Patients
Authors: Loftus Christopher M. , Biller José , Godersky John C. , Adams Harold P. , Yamada Thoru , Edwards Pamela S.
Published: May 2010

Fifty-three of 203 consecutive carotid endarterectomies (26%) performed on the Neurosurgical Service at the University of Iowa were in patients over 70 years of age (mean age, 73.4). This series included 38 men and 15 women. Thirty-three patients (62%) presented with transient ischemic attacks, and the remaining 38% were functional stroke patients. Medical risk factors in this group included hypertension in 70%, previous myocardial infarction in 26%, angina in 17%, peripheral vascular disease in 23%, and diabetes in 13%. Sixty-four per cent of the patients had been previously treated with antihypertensive drugs, 43% with antiplatelet agents, and 4% with anticoagulants. Noninvasive vascular evaluation was performed in 25 of 53 (47%) patients, and all underwent angiography before operation. There were no angiographic complications. All patients were operated on with full-channel electroencephalographic (EEG) monitoring. Indwelling shunts were required in 6 of 53 (11%) cases. Intraoperative heparin was given and not reversed; the mean dose was 5100 units. The mean clamp time was 48 minutes. Patch grafts, fashioned from common facial or saphenous veins, were used in 2 patients. Eight patients had contralateral carotid occlusions, but only 2 (25%) required indwelling shunt placement based on EEG criteria. There were no perioperative deaths in this series. One patient had a postoperative stroke, and 1 patient had a postoperative nonfatal myocardial infarction. Transient surgical complications included 3 wound hematomas, 1 wound abscess, and 2 self-limited cranial nerve palsies (13%). The mean follow-up was 12.7 months, during which no new neurological events were identified in any patient. Carotid endarterectomy can be performed in symptomatic elderly patients with a risk/benefit ratio equal to that of younger patients.
Treatment of Symptomatic Syringomyelia with a Ventriculoperitoneal Shunt: A Case Report with Magnetic Resonance Scan Correlation
Authors: Ogilvy Christopher S. , Borges Lawrence F.
Published: May 2010

This report describes a patient with communicating syringomyelia associated with enlarged cerebral ventricles who was managed by placing a ventriculoperitoneal shunt. His clinical improvement was rapid and dramatic. A comparison of preoperative and postoperative magnetic resonance scans documents shrinkage of the cervical syrinx.
Cellular Blue Nevus (“Melanocytoma”) of the Spinal Meninges: Electron Microscopic and Immunohistochemical Features
Authors: Lach B. , Russell N. , Benoit B. , Atack D.
Published: May 2010

A primary cellular blue nevus (melanocytoma) of the spinal canal in a 21-year-old woman is reported. Light microscopic examination revealed a melanotic neoplasm with histological patterns resembling schwannoma, dermal nevi, and neuroblastic-like tumor. The ultrastructural features of the neoplastic cells were similar to those in dermal blue nevi and melanomas. There was no evidence of arachnoidal cell differentiation. Immunohistochemistry revealed positive reactions for S-100 protein and neuron-specific enolase in many cells and no reactions for glial fibrillary acidic protein, cytokeratins, epithelial membrane antigen, 70-kD neurofilament protein, or Leu-7. Vimentin was strongly positive in the melanocytic cells as well as in the arachnoidal cells of involved meninges. The ultrastructural and immunohistochemical features support the nevoid nature of this tumor, which is frequently mislabeled as “melanotic meningioma.”
Pre- and Postoperative Changes in Brain Tissue Surrounding a Meningioma
Authors: Trittmacher Susan , Traupe Horst , Schmid Anton
Published: May 2010

A retrospective study in 33 patients with intracranial meningioma demonstrates that two pathological mechanisms are involved in causing a hypodense area around the actual tumor: pressure-induced atrophy that persists after operation and true cerebral edema of unclear cause. The extent of the hypodense area is not related to tumor location or tumor size. A relationship between meningioma with a malignant tendency and the hemispheric spread of hypodensity can be observed.
Factors Possibly Influencing the Prognosis of Oligodendroglioma
Authors: Sun Zhen Min , Genka Shigeru , Shitara Nobuyuki , Akanuma Atsuo , Takakura Kintomo
Published: May 2010

Fifty-seven cases of oligodendroglioma (including eight cases of malignant oligodendroglioma) treated at the University of Tokyo Hospital between 1961 and 1985 were analyzed for factors influencing the survival rate. Factors related to a poor outcome were findings of malignancy and symptoms of dementia. Survival rate and postoperative survival period were not influenced significantly by radiation therapy, extent of resection, tumor characteristics, or ABO blood groups.