bluuebunny/crossref_metadata_2025 huggingface dataset:
Enlargement and Rupture of Distal Basilar Artery Aneurysm after Iatrogenic Carotid Occlusion
Authors: Batjer Hunt , Mickey Bruce , Samson Duke
Published: May 2010

A case of angiographic enlargement and fatal rupture of a previously asymptomatic distal basilar aneurysm in a 12-year-old girl is reported. She had been treated by carotid sacrifice for a giant intracavernous carotid aneurysm. After superficial temporal-middle cerebral artery bypass, this patient underwent a trapping procedure and decompression of her symptomatic giant aneurysm. Despite postoperative patency of her bypass graft, the involved middle cerebral circulation was irrigated substantially by retrograde flow through her posterior communicating artery. An incidental distal basilar aneurysm involving the origin of her superior cerebellar arteries, posterior cerebral arteries, and multiple perforators was treated by a wrapping procedure. Eleven days after carotid ligation, she suffered a fatal subarachnoid hemorrhage from her basilar aneurysm. This catastrophe was undoubtedly produced by our failure to consider the additional hemodynamic stress placed upon the distal basilar artery by carotid sacrifice and may have been preventable by a more aggressive attack on this previously asymptomatic lesion.
Spontaneous Reduction of a Closed Depressed Skull Fracture: A Case Report
Authors: Cozzens Jeffrey W. , Eller Theodore W.
Published: May 2010

Presented is a single case of a 6-year-old child in whom a closed depressed skull fracture was found to be elevated spontaneously less than 2 days after the injury. There were no cosmetic or neurological sequelae at follow-up. This case demonstrates that these injuries do not always require operation and that they occasionally resolve spontaneously, even in school-age children.
Extradural Lymphoma Presenting as an Acute Surgical Emergency
Authors: Rabin David N. , Ramsey Ruth G. , Vedanthum Kizhanatham S. , Foust Robert J. , Rabin Michael
Published: May 2010

Extradural lymphoma can present as an acute neurosurgical emergency. The clinical presentation and radiological appearance may suggest epidural hematoma or meningioma. Lymphoma should be considered as a rare but possible diagnosis before operation. High resolution computed tomography using direct coronal imaging with and without contrast enhancement may aid in suggesting the correct preoperative diagnosis.
Agenesis of Internal Carotid Artery Presenting with Oculomotor Nerve Palsy after Minor Head Injury
Authors: Wakai Susumu , Watanabe Naofumi , Inoh Satoshi , Ochiai Chikayuki , Nagai Masakatsu
Published: May 2010

We report a patient with unilateral agenesis of the internal carotid artery in whom the oculomotor nerve was paralyzed on the same side as the agenesis after a minor head injury. It is conceivable that the palsy was caused by sudden tension of the nerve between the petroclinoid ligament and the enlarged posterior communicating artery.
Brachytherapy of Recurrent Tumors of the Skull Base and Spine with Iodine-125 Sources
Authors: Gutin Philip H. , Leibel Steven A. , Hosobuchi Yoshio , Crumley Roger L. , Edwards Michael S. B. , Wilson Charles B. , Lamb Sharon , Weaver Keith A.
Published: May 2010

Thirteen patients with recurrent, previously irradiated tumors of the skull base or spine were reirradiated with 125I sources implanted interstitially using microsurgical or stereotactic techniques. Patients harbored difficult, end-stage recurrences of chordoma, meningioma, malignant meningioma, fibrosarcoma, invasive pituitary adenoma, and malignant schwannoma. In two other patients with malignant meningioma, the dose of external radiation was augmented by implanting 125I sources during the initial operation for excision of the lesion or at a separate surgical procedure after conventional teletherapy. Microsurgical implantation of 125I sources into basal tumors was limited by the difficulties inherent in operating in this region; it is not possible to visualize the entire tumor that requires implantation. Three of five chordomas stabilized or regressed; these patients probably benefited from the procedure. Two patients with recurrent malignant meningiomas had long term remission after interstitial brachytherapy. Interstitial 125I brachytherapy for recurrent tumors at the base of skull or adjacent to the spine can be more successful only if more aggressive surgical exposures of these regions are attempted. Implantation of sources for a “boost” dose, either microsurgically during the initial surgical resection of the lesion before conventional teletherapy or stereotactically after conventional teletherapy, may be a valuable adjunct to external irradiation for the control of potentially devastating tumors (such as chordomas and malignant meningiomas) before they recur with the severe consequences seen in the patients reported here.
Pituitary Adenoma Composed of Two Compartments Each Secreting Prolactin or Growth Hormone
Authors: Tomono Yuji , Nose Tadao , Maki Yutaka
Published: May 2010

We report a case of pituitary adenoma with two compartments, i.e. a part within the sella turcica and a part infiltrating the sphenoid bone beneath the sella, producing growth hormone (GH) and prolactin. The patient had the amenorrhea-galactorrhea syndrome, but not acromegalic symptoms. Although the two compartments were united through a small dural perforation, immunohistochemical studies demonstrated that GH and prolactin were separately secreted from the intrasellar and extrasellar components, respectively. Somatotropic adenomas frequently produce prolactin, but it is unusual for these hormones to be secreted from distinctly different parts of the same lesion. (Neurosurgery 21: 56-59, 1987)
Malignant Melanoma Metastatic to Sphenoid Bone with an Unknown Primary Origin: Report of a Case with an Immunohistochemical Analysis of the Infiltrating Lymphocytes
Authors: Yamasaki Toshiki , Handa Hajime , Paine Jonathan T. , Moritake Kouzo
Published: May 2010

A rare case of hemorrhagic metastatic malignant melanoma from an unknown primary origin to the right sphenoid bone in a 37-year-old woman is presented. The tumor occupied an extensive intracranial extradural space with a mild orbital infiltration, but little involvement of the leptomeninges and parenchymal tissues. Immunohistochemical analysis of the tumor-infiltrating lymphocytes showed that the majority expressed pan-T or Leu-1 surface antigens and that the lymphocytes bearing the Leu-3 antigen, or helper phenotype, were predominant compared to the Leu-2 population representing both suppressor and cytotoxic T cells. Furthermore, most of the T lymphocytes stained with HLA-DR antigens. Because few B cells were seen, this observation indicates the presence of T cells in an activated state. The literature pertinent to associated organ involvement of metastatic melanomas and the correlations between the tumor and immunological cellular responses are discussed. (Neurosurgery 21: 73-77, 1987)
Tuboovarian Abscess Presenting as Sciatic Pain: Case Report
Authors: Andrews David W. , Friedman Neil B. , Heier Linda , Erickson Amelia , Lavyne Michael H.
Published: May 2010

The authors report the successful conservative treatment of a tuboovarian abscess in a 25-year old woman who presented with low grade fever and severe right sciatic pain. Computed tomography and ultrasonography corroborated a clinical diagnosis of tuboovarian abscess after an initial diagnosis of epidural abscess had been made. This is the first report of a tuboovarian abscess presenting principally as sciatic pain. The diagnosis and treatment of this lesion are discussed. (Neurosurgery 21: 100-103, 1987)
Spontaneous Intracerebellar Hematoma during Childhood
Authors: Freitas Paulo Eduardo , Aquini Mauro Guidotti
Published: May 2010

The case of a surgically treated spontaneous intracerebellar hematoma in a 6-year-old girl is reported. Such hemorrhages in this age group are very rare, but must be recognized and promptly treated. Usually associated with the rupture of vascular malformations, they are different from those occurring in adults, and operation is indicated to secure a favorable prognosis (Neurosurgery 21: 103-105, 1987)
Hemoglobinemia and Renal Failure from an Intracerebral Hematoma Simulating a Vein of Galen Aneurysm
Authors: Chovanes George I. , Truex Raymond C.
Published: May 2010

A case of an intracranial hematoma in a neonate causing the release of free hemoglobin into the plasma is presented. No previous such case has been described. The relationship between hemoglobinemia and the occurrence of acute renal failure in this neonate is discussed, with comments on the possible etiological role of the hemoglobinemia. (Neurosurgery 21: 107-109, 1987)
Pulmonary Complications of Acute Spinal Cord Injuries
Authors: Reines David H. , Harris Robert C.
Published: May 2010

The records of 123 consecutive patients admitted with spinal cord injury were examined for the presence of pulmonary complications. Forty-nine had tetraplegia and 23 had paraplegia; the remainder suffered a variety of neurological deficits. Multiple injuries were encountered in 36 patients. Fifty-three pulmonary complications were noted in 44 (35.7%) patients. The most common problems were atelectasis and pneumonia. There were 22 (18%) deaths. Fourteen deaths were related to pulmonary complications. The mean age of patients who died was 52 ± 13 (SE) compared to 28 ± 12 for survivors. A mean forced vital capacity (FVC) of 1127 ± 410 cc in patients suffering respiratory difficulties compared to a FVC of 1865 ± 85 cc in patients without complications (P < 0.001). Oxygenation (PaO2 90 ± 19 torr) was normal in patients without respiratory problems and was abnormal in patients developing problems (PaO2 76 ± 30 torr; P < 0.05). Twenty patients were treated with a rotating bed. The complication rate of patients on the bed was only 10%. In conclusion, respiratory problems remain a significant cause of morbidity and mortality in spinal cord injury. The forced vital capacity, blood oxygen tension, and age are predictors of pulmonary complications. The use of a multidisciplinary approach and a rotating bed may minimize these problems.
Cushing's Syndrome Caused by an Ectopic Pituitary Adenoma
Authors: Schteingart David E. , Chandler William F. , Lloyd Ricardo V. , Ibarra-Perez Gloria
Published: May 2010

A 49-year old woman with a 5-year history of Cushing's syndrome was evaluated. Biochemical measurements revealed high cortisol and adrenocorticotropic hormone (ACTH) levels consistent with the ACTH-dependent type of Cushing's syndrome. However, the source of ACTH seemed to be autonomous as she demonstrated abnormal feedback control, with lack of response to metyrapone and high doses of dexamethasone. A search for an ectopic ACTH-secreting nonpituitary neoplasm was unsuccessful. Transsphenoidal pituitary exploration revealed a normal pituitary gland, but an ectopic pituitary adenoma was found incidentally in the mucosa of the sphenoid sinus. This adenoma stained strongly positive for ACTH on immunocytochemical studies. Resection of this lesion led to remission of the Cushing's syndrome. This variant of ACTH-dependent Cushing's syndrome can mimic the ectopic ACTH-dependent type and should be looked for in patients who fail to respond to pituitary operation.
“Caval-Septal” Hematoma: Does It Exist?
Authors: Schulder Michael , Hirano Asao , Elkin Charles
Published: May 2010

A “caval-septal” hematoma shown by computed tomography has been described in cases of ruptured aneurysms arising from the anterior communicating artery. This term seems to imply that the hematoma is confined to the cavum septi pellucidi. This common finding almost always represents a hematoma in the anterior interhemispheric fissure.
Association of a Ganglioneuroma with an Arteriovenous Malformation: Case Report
Authors: Chovanes George I. , Truex Raymond C.
Published: May 2010

The unusual concurrence of a brain tumor and an arteriovenous malformation (AVM) is discussed in this case report. A 12-year-old child presented with a severe headache, and an intracerebral mass was found on neuroradiological study. At operation, we encountered a superficial AVM, not shown on the computed tomogram or arteriogram. At a second procedure, a ganglioneuroma was removed. The literature on the concurrence of these two entities is reviewed; comments are made on the pathology of ganglion cell tumors.
Staged Treatment of Arteriovenous Malformations of the Brain
Authors: Andrews Brian T. , Wilson Charles B.
Published: May 2010

Twenty-eight patients treated for arteriovenous malformations (AVMs) of the brain had staged therapy consisting of multiple surgical procedures or endovascular embolization followed by surgical treatment. There were 10 men and 18 women, aged 15 to 60 years (mean, 34 years). The clinical symptoms were those associated with intracranial hemorrhage in 13 patients, progressive neurological deficit not due to hemorrhage in 6, intractable headache in 5, and seizures in 4. Four groups were identified based upon the reason for staging therapy. Thirteen patients with large high flow AVMs (Group A) had staged treatment because of the risk of normal perfusion pressure breakthrough. The initial afferent artery occlusion was accomplished surgically in 9 patients and by endovascular embolization in 4. Postoperatively, no patient in this group had malignant cerebral edema or intracranial hemorrhage suggestive of normal perfusion pressure breakthrough, but 1 patient had an intraventricular hemorrhage after initial embolization. In 9 patients (Group B), the AVM had a complex multiple arterial supply that precluded resection from a single operative exposure. Seven had supratentorial AVMs, and 2 had AVMs of the posterior fossa. In 6 of these cases, the AVM was located in the midline and received bilateral arterial input. Six patients had staged surgical procedures, and 3 had an initial endovascular embolization followed by operation. Two patients had intracerebral hemorrhages, one after an initial surgical procedure and another after initial embolization. In 4 patients (Group C), the AVM had a major dural component that was treated separately from the parenchymal component. In 3 of these patients, embolization through the external carotid artery satisfactorily obliterated the dural component; in the remaining patient, a persistent internal carotid supply necessitated resection of the dural malformation. The parenchymal component was excised surgically in 2 patients. Two patients (Group D) had separate surgical procedures to treat an aneurysm associated with a parenchymal AVM. Overall, 19 of 28 patients had complete excision and 9 had partial obliteration of their AVMs. Late follow-up of 27 patients at a mean of 18.6 months showed that 16 patients were in excellent condition and 8 were in good condition. Three patients were in poor condition with debilitating neurological deficits. One patient had a delayed intracranial hemorrhage 22 months after incomplete obliteration of her AVM. Staged treatment of selected AVMs of the brain may avoid the occurrence of normal perfusion pressure breakthrough. This approach also allows satisfactory obliteration of selected malformations that have multiple complex arterial supplies or a dural component and those associated with an aneurysm.
Foraminal Cervical Herniated Disc Treated by Anterior Discoforaminotomy
Authors: Lesoin F. , Biondi A. , Jomin M.
Published: May 2010

The authors report their experience with cervical foraminal disc herniation. The importance of the computed tomographic scan in its diagnosis is emphasized, and discoforaminotomy is described.
T2 and T3 Sympathetic Ganglia in the Adult Human: A Cadaver and Clinical-Radiographic Study and Its Clinical Application
Authors: Yarzebski J. L. , Wilkinson H. A.
Published: May 2010

The technique of percutaneous radiofrequency (RF) upper thoracic sympathectomy mandates an exact knowledge of the anatomical location of the sympathetic ganglia. Because conflicting descriptions are given in anatomy texts, we examined the T2 and T3 sympathetic ganglia in 48 sympathetic chains in adult cadavers to measure the exact location of the ganglia. Measurements were made relative to their distances (a) dorsal to the ventral surface of the vertebral body and (b) rostral or caudal to the midpoint of the vertebral body. Median locations of T2 and T3 ganglia were 17 to 20 mm dorsal to the ventral surface of the vertebral body and 2 mm rostral to the T1-T2 and T2-T3 vertebral bodies. The sympathetic chains lay lateral to and between the heads of the ribs at these levels. A clinical-radiographic correlation study of the sympatholytic effectiveness of various needle electrode placement sites during sympathectomy confirmed these findings. These data have been used to modify the technique of percutaneous RF sympathectomy.
Metastasis within a Pituitary Adenoma Presenting with Bilateral Abducens Palsies: Case Report and Review of the Literature
Authors: Zager Eric L. , Hedley-Whyte Tessa E.
Published: May 2010

A 56-year-old woman with metastatic breast carcinoma presented on her terminal hospital admission with diplopia secondary to bilateral abducens nerve palsies. Postmortem examination revealed a sellar mass composed of an unsuspected pituitary adenoma infiltrated by metastatic carcinoma. Review of the literature revealed only seven patients with this rare neoplasm-to-neoplasm metastasis, none of whom were reported to have had abducens palsies.
Arteriovenous Malformation Associated with Multiple Aneurysms in the Posterior Fossa: A Case Report with a Review of the Literature
Authors: Noterman J. , Georges P. , Brotchi J.
Published: May 2010

The association of two aneurysms on the distal posteroinferior cerebellar artery with an arteriovenous malformation fed by the same artery is reported. A one-stage operation was performed. The other cases in the literature are analyzed with particular regard to the origin of the subarachnoid hemorrhage and the location of the aneurysms.
Reversible Somatosensory Evoked Potential Changes with Neodymium: Yttrium-Aluminum-Garnet Laser Use
Authors: Long Randall R. , Wirth Fremont P.
Published: May 2010

Reversible prolongation and dissolution of the tibial somatosensory evoked potential (SEP) was observed with operative use of the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser during extirpation of a foramen magnum meningioma. Rapid normalization of the SEP followed irrigation with cool saline. The absence of postoperative dorsal column deficit suggests that heat-related physiological changes occurred before the point of irreversible tissue injury. Should intraoperative SEP monitoring prove a reliable index of tissue temperature, it could enable safer use of the Nd:YAG laser in the vicinity of the spinal cord and brain stem.
Large Pituitary Gland Adenomas Evaluated with Magnetic Resonance Imaging
Authors: Kaufman Benjamin , Kaufman Bruce A. , Arafah Baha'Uddin M. , Roessmann Uros , Selman Warren R.
Published: May 2010

Magnetic resonance imaging (MRI), computed tomographic (CT) scanning, and angiography or digital subtraction angiography (DSA) were used preoperatively to evaluate 16 surgically proven cases of sellar tumor with extrasellar extension. There were 15 pituitary tumors and 1 schwannoma. The capabilities of MRI in evaluating these tumors were compared with CT scanning and angiography. Bone destruction and tumor calcification were better detected by CT scanning than by MRI. MRI was as effective as CT scanning in detecting a cyst or variation in tumor consistency. Neither MRI nor CT scanning was capable of distinguishing specific tumor types. In every case, MRI was superior to CT scanning for delineating spatial relationships of the tumor to the 3rd ventricle, the optic apparatus, adjacent brain, and parasellar vasculature. Vessel encasement by tumor was clearly seen on MRI when there was no direct indication of this on other studies. Cavernous sinus invasion was not demonstrated by CT scanning, but was indicated by MRI in 5 cases and was surgically confirmed in 3. MRI can provide more precise spatial information on extrasellar tumor extension. Vascular encasement and cavernous sinus invasion may be determined preoperatively. Treatment expectations and operative approaches can be guided by this information. When MRI is available, it is the test of choice for the preoperative evaluation of patients with suspected large pituitary gland (sellar region) tumors. Contrast-enhanced CT scanning and angiography can be used as supplementary studies to add information inherently unique to these techniques. (Neurosurgery 21:540-546, 1987)
Spinal Cord Compression from Metastasizing Cicatrial Carcinoma: A Case Report
Authors: Gilling Peter John , MacFarlane Martin Richard , Rhode Jeffrey Charles
Published: May 2010

Spinal cord compression from a metastasizing burn scar cancer has not previously been reported. A patient with rapidly progressive paraparesis associated with vertebral collapse and an extradural soft tissue mass of undetermined origin is presented. The clinical history, radiological diagnosis, and histological features of cicatrial carcinoma are discussed along with a brief review of the relevant literature. (Neurosurgery 21:553-557, 1987)
Gliosarcoma with Chromosome Abnormalities in a Neonate Exposed to Heptachlor
Authors: Chadduck William M. , Gollin Susanne M. , Gray Brian A. , Norris James S. , Araoz Carlos A. , Tryka Franci A.
Published: May 2010

A neonate with a cerebral gliosarcoma was found to have chromosome abnormalities in tissue culture of the tumor, but normal karyotyping of peripheral blood. Similarities to and differences from chromosome abnormalities found in other human gliomas are noted. Unusual exposure of the child to heptachlor during prenatal development and the neonatal period suggests the need for further studies on the role of toxins in oncogenesis. (Neurosurgery 21:557-559, 1987)
Solitary Eosinophilic Granuloma of the Frontal Lobe
Authors: Penar Paul L. , Kim Jung H. , Chyatte Douglas
Published: May 2010

Solitary intracranial eosinophilic granulomas are rare and most frequently involve the hypothalamus. We report an unusual case of solitary eosinophilic granuloma of the frontal lobe in a patient without evidence of systemic disease. Previously reported cases of solitary intracranial nonhypothalamic lesions are reviewed, and the clinical, radiographic, and histological features of this case are discussed.
Fixation System for Cervical Spinal Operation: Application of the Head Fixation System and Multipurpose Cervical Frame
Authors: Kyoshima Kazuhiko , Kobayashi Shigeaki , Sugita Kenichiro
Published: May 2010

We have designed a multipurpose cervical frame to use with our operative head fixation system and have used it in 60 cervical spinal operations including anterior, posterior, lateral, and transoral approaches, with satisfactory results. We emphasize the following advantages of this system: (a) Both stability and an exact position of the cervical spine can be maintained during operation. (b) Positioning of patients for operation, including those with a halo vest, is efficiently carried out with safety and ease. (c) Our newly designed cervical frame enables exact and refined intraoperative retraction with various kinds of retractors. (d) When microsurgery is performed, the surgeon can sit at the patient's head in an operating chair.
Long Term Results of Ruptured Aneurysms Treated by Coating
Authors: Minakawa Takashi , Koike Tetsuo , Fujii Yukihiko , Ishii Ryoji , Tanaka Ryuichi , Arai Hiroyuki
Published: May 2010

We report the long term results of the treatment of 23 intracranial ruptured aneurysms by coating. Twenty-three patients treated by coating were followed for a mean period of 11.2 years. The mean interval between the last hemorrhage and the operation was 22.4 days. Ten aneurysms underwent total coating, 9 with Biobond and 1 with Aron Alpha. Thirteen aneurysms underwent partial coating, 11 with Biobond and 2 with Aron Alpha. Six aneurysms were reinforced partially by other materials, but no aneurysm was wrapped totally with these materials. Rebleeding occurred in 6 patients, of whom 5 died. The mean interval between coating and rebleeding was 4 years. All patients suffering rebleeding had been treated with Biobond, and 3 patients had undergone total coating of aneurysms. The risk of recurrent hemorrhage after total coating with Biobond was 33%. One rebleeding patient underwent a second operation 10.5 years after total coating of the aneurysm. Biobond was found only at the tip of the aneurysmal sac. From these results, reinforcement of ruptured aneurysms with Biobond seems to be of little value, and a more reliable method must be developed for aneurysms that cannot be clipped. (Neurosurgery 21:660-663, 1987)
Are Flash-evoked Visual Potentials Useful for Intraoperative Monitoring of Visual Pathway Function?
Authors: Cedzich Cornelia , Schramm Johannes , Fahlbusch Rudolf
Published: May 2010

Flash-evoked visual potentials (VEPs) recorded from the scalp were used in a series of 35 patients with tumors along the visual pathway: 3 orbital tumors, 25 perisellar tumors, 4 intraventricular tumors, and 3 occipital lesions. Preoperatively, various combinations of impaired visual fields and visual acuity were observed in over 90% of the patients. A postoperative decrease in visual function was observed in 3 cases. Of the 25 perisellar lesions, 13 were operated through a standard frontotemporal craniotomy and 12 were operated through a transnasal-transsphenoidal approach. VEPs were highly susceptible to volatile anesthetics, and there was a significant incidence of spontaneous latency increases and amplitude decreases in a large number of patients. There was an unacceptably high number of cases with significant VEP alteration occurring without concomitant visual function change. During trepanation or the transnasal approach, a reversible potential loss was observed in 11 patients, a profoundly altered wave form was seen in 8 cases, and a loss of single peaks was observed in 15 patients. During dissection of the tumor, a reversible potential loss or a potential with unidentifiable peaks was found in 25 cases; however, the VEPs recovered during closure or in the recovery room. There was no correlation between intraoperative VEP changes and the postoperative changes in visual function. In only 1 patient with an insignificant postoperative decrease in visual acuity from 0.4 to 0.3 was there a concomitant intraoperative potential loss. The major conclusion of our findings is that light-emitting diode flash-evoked VEPs demonstrate intraoperative changes that appear too early and too prominently to be caused solely by manipulation of the optic pathways. Therefore, light-emitting diode flash-evoked potentials do not seem to be a suitable instrument for the intraoperative monitoring of visual pathway function. (Neurosurgery 21:709-715, 1987)
Isolated Histiocytosis X of the Pituitary Gland: Case Report
Authors: Nishio Shunji , Mizuno Junichi , Barrow Daniel L. , Takei Yoshio , Tindall George T.
Published: May 2010

The authors describe a case of a granuloma of histiocytosis X localized in the pituitary gland. The patient presented with diabetes insipidus and hyperprolactinemia. The diagnosis was established by surgical removal of the pituitary lesion through a transsphenoidal approach. The clinical and pathological aspects of the case are discussed. (Neurosurgery 21:718-721, 1987)
Epidural Lipomatosis Simulating an Epidural Abscess: Case Report and Literature Review
Authors: Haid Regis W. , Kaufman Howard H. , Schochet Sydney S. , Marano Gary D.
Published: May 2010

A case of epidural lipomatosis in a 49-year-old man presenting with paraparesis, midthoracic pain, and Staphylococcus aureus pneumonia is reported. The patient had been on low dose corticosteroid therapy for 7 years for rheumatoid arthritis. The clinical and myelographic findings suggested a diagnosis of epidural abscess, but the only abnormality discovered at operation was abundant fatty tissue in the dorsal epidural space significantly compressing the spinal cord, and this was partially removed. Postoperative neurological improvement suggested that the lipomatosis was responsible for the spinal cord compression and dysfunction. If this diagnosis had been suspected, it might have been confirmed by magnetic resonance imaging or postmyelography computed tomographic scanning. With such a diagnosis, an alternative treatment could have been to decrease the steroid dose, observe for clinical improvement, and perhaps avoid operation. (Neurosurgery 21:744-747, 1987)
Posterolateral Extradural Approach for Total Excision of Lateral Thoracic Meningocele: Technical Report
Authors: Chee Chee Pin
Published: May 2010

The author describes a posterolateral extradural approach for total excision of small to moderate symptomatic lateral thoracic meningoceles. Its advantages over the classical laminectomy, intradural repair, and thoracotomy excision are discussed.
Surgical Management of Children with Temporal Lobe Epilepsy and Mass Lesions
Authors: Drake J. , Hoffman Harold J. , Kobayashi J. , Hwang P. , Becker L.E.
Published: May 2010

In a review of 48 children who underwent temporal lobectomy for temporal lobe epilepsy, 16 patients had mass lesions in the temporal lobe. These mass lesions consisted of 12 tumors, 3 vascular malformations, and 1 arachnoid cyst. In 9 of 10 patients where the hippocampus was present in the pathological specimen and was not involved by tumor, there was concomitant mesial temporal sclerosis. All 16 patients have been followed for more than 1 year. Nine are free of seizures, with 4 of these 9 still on medication. Seven patients have had a greater than 50% reduction in seizures.
Epidermoid Cysts and Cholesterol Granulomas Centered on the Posterior Fossa: Twenty Years of Diagnosis and Management
Authors: Sabin Howard Ian , Bordi Lorenzo Tommaso , Symon Lindsay
Published: May 2010

The clinical features, diagnosis, and management of 23 posterior fossa epidermoid cysts and 9 petrous apex lesions presenting to one unit over a period of 20 years are summarized. Of the epidermoid cysts, 13 were entirely infratentorial, but the other 10 had an additional supratentorial component. Presenting symptoms and signs were usually long-standing and at onset had often been vague and nonspecific. With time, however, a variety of neurological deficits that depended on the site of the lesion developed. These were generally combinations of cerebellopontine (CP) angle and jugular foramen syndromes, deafness, facial palsy, and motor weakness. Diagnostic procedures have changed greatly over the review period. Computed tomography and magnetic resonance imaging have replaced air encephalography and contrast ventriculography. The better preoperative localization of these lesions allows rational planning of the surgical approach required for optimal tumor exposure, which is essential for any attempt at total excision, considering the large size of the majority of these tumors when diagnosed. We favor operation through a posterior fossa craniectomy for those tumors restricted to the CP angle or 4th ventricle, but routinely use a combined supra- and infratentorial approach if the lesion has a more rostral component. The infiltrating nature of epidermoid cysts within the cranium compromises the extent of excision if neurological deficit is not to be increased, but we attempt as complete an excision of tumor and capsule as possible in the hope that many years will pass before symptoms recur. Cholesterol granulomas seem to respond well to simple cavity drainage and have shown no tendency to recur.
Monitoring of Transient Central Nervous System Postirradiation Effects by 133Xe Inhalation Regional Cerebral Blood Flow Measurements
Authors: Hylton Phillip D. , Reichman Howard O. , Palutsis Roberta
Published: May 2010

The early transient postirradiation effects in the central nervous system are well known; however, no specific means of objective follow-up have been devised. The xenon (133Xe) inhalation technique for measurement of regional cerebral blood flow (rCBF) is easily reproducible. Serial rCBF measurements corresponding to the clinical presentation and course of the early postirradiation syndrome have not been previously reported. It is our belief that the global decline in rCBF identified in these patients represents a generalized metabolic derangement induced by whole brain irradiation rather than primary vascular changes. A distinction between tumor recurrence and the early transient postirradiation effects can be made utilizing this technique. It also provides a reproducible monitor of the clinical and metabolic impact of radiotherapy for brain tumors. A series of seven such patients is presented with appropriate case histories and graphic representations of the serial rCBF measurements.
Experience with the Neodymium:Yttrium-Aluminum-Garnet Laser in Forty-two Cases
Authors: Wirth Fremont P. , Downing Edward F. , Cannon Clifton L. , Baker Roy P.
Published: May 2010

The neodymium:yttrium-aluminum-garnet (Nd:YAG) laser has been utilized in the treatment of 42 cases during the past 2 years at two institutions. The laser was used under investigational permits from the Food and Drug Administration. It was found to be of particular value in the treatment of vascular intracranial tumors, especially meningiomas, and metastatic tumors of the spine. The ability of the laser to shrink and devascularize these tumors was efficacious as a surgical adjunct. Laser treatment of tumor attachments, especially those of meningiomas to the skull base, seemed to be effective in eradication of residual tumor. Long term benefits of such therapy, however, remain unproven. Because of the penetrating ability of the Nd:YAG laser beam, this device must be used with care by surgeons experienced in its use to prevent injury to adjacent structures.
Primary Cerebral Lymphoma in Two Consortial Partners Afflicted with Acquired Immune Deficiency Syndrome
Authors: Capanna Albert H. , LaMancusa Joseph , Erculei Franco , Fathie Kazem , Christenson Peter , Mulkey David A.
Published: May 2010

Two consortial partners presented within 3 weeks of one another with signs and symptoms of neurological dysfunction. Both were found to have acquired immune deficiency syndrome (AIDS) and primary cerebral lymphoma. We found 17 case reports of primary central nervous system (CNS) lymphoma in AIDS patients. Ten of these cases were described sufficiently to enable analysis. Our 2 cases are unique in that this is the first time primary CNS lymphoma has been reported in sexual partners with AIDS. One case includes the use of magnetic resonance imaging. Both patients underwent craniotomy and received radiation therapy.
Brain Abscesses and Ischemic Necrotic Lesions During Early Childhood
Authors: Tavora Luis , Antunes Lobo J.
Published: May 2010

The cases of seven children, all under 6 months of age, with cerebral abscesses are presented. In four cases, there was previous meningitis; the others presented with expanding mass lesions. The infectious agent was Proteus in four cases and Escherichia coli and Citrobacter in one each; in another patient, no agent was isolated. In six children, there were multiple areas of ischemic necrosis. In one instance, these areas were in the hemisphere contralateral to the purulent collection. The peculiar clinical, diagnostic, and therapeutic aspects of brain abscesses in this age group are discussed.
Intravascular Papillary Endothelial Hyperplasia in an Intracranial Cavernous Hemangioma
Authors: Izukawa D. , Lach B. , Benoit B.
Published: May 2010

A novel presentation of intravascular papillary endothelial hyperplasia within a cerebral cavernous angioma in an adult is described. The pathogenesis of the lesion and its histological differentiation from malignant angiosarcoma are stressed.
A New Method of Occipitocervical Fusion Using Internal Fixation
Authors: Flint Graham A. , Hockley Anthony D. , McMillan James J. , Thompson Alistair G.
Published: May 2010

We describe a method for decompression and fusion of the occipitocervical junction in cases of atlantoaxial subluxation. Use of an implanted steel rectangle provides immediate rigid internal fixation, permitting early mobilization with minimal external support.
Cavernous Carotid Artery Aneurysm Associated with Marfan's Syndrome: Treatment by Balloon Embolization Therapy
Authors: Higashida Randall T. , Van Halbach V. , Hieshima Grant B. , Cahan Leslie
Published: May 2010

Intracranial aneurysms arising in the region of the cavernous carotid artery are difficult to manage surgically because of the surrounding cavernous sinus. With recent advances in microballoon technology and permanent solidification agents, it is now possible to treat certain intracranial aneurysms by detachable balloons and preserve the parent vessel. A patient with Marfan's syndrome presented with severe retroorbital pain, ophthalmoplegia, and headaches. Cerebral angiography demonstrated a large cavernous carotid artery aneurysm measuring 17 × 9 × 6 mm. This was successfully treated by placing three detachable balloons within the aneurysm and preserving the carotid artery via a transvascular approach. Intravascular detachable balloon embolization may offer a form of alternative therapy for the management of surgically difficult aneurysms. (Neurosurgery 22:297-300, 1988)
Diagnosis and Surgical Treatment of Spasmodic Torticollis of 11th Nerve Origin
Authors: Shima Fumio , Fukui Masashi , Kitamura Katsutoshi , Kuromatsu Chiharu , Okamura Tomomi
Published: May 2010

Of 22 patients with spasmodic torticollis, 7 were treated by microsurgical decompression of the 11th nerve. In these patients, there was an intermittent horizontal torticollis characterized by aggravation of the symptoms when in a resting posture, presenting with a striking contrast to the torticollis of extrapyramidal origin that was alleviated while in the resting posture and aggravated by postural stress. A tight neurovascular contact was observed at the C1 level, occurring between the principal 11th nerve and the vertebral or posterior inferior cerebellar artery. Nerve decompression was achieved in 2 by transposing the compressing artery and in 5 by sectioning at C1 or C2 the branching root of the 11th nerve that had caused the tight cross contact by locking the nerve trunk to the dura mater. The symptoms had improved after an interval of 1 to 4 weeks. After an average follow-up of 3 years, full or satisfactory relief had been obtained in 5 and some improvement had occurred in 2 patients. Possible neural mechanisms related to torticollis of 11th nerve origin are discussed. (Neurosurgery 22:358-363, 1988)
Return of Gonadal Function with Resection of Nonfunctioning Pituitary Adenoma
Authors: Ober K. Patrick , Kelly David L.
Published: May 2010

A 42-year-old man with severe testicular failure (testosterone 24 ng/dl, normal 300-1100) was found to have a nonfunctioning chromophobe pituitary adenoma. Resection of the pituitary tumor resulted in recovery of gonadal function (testosterone 359 ng/dl). Hypogonadism caused by pituitary adenomas is usually attributed to either hyperprolactinemia or irreversible destruction of normal pituitary tissue, neither of which is applicable to this patient. The recovery of our patient's gonadal function after operation suggests that a reversible compression of viable tissue or impairment of hypothalamic-pituitary communications was responsible for his endocrine deficiency. (Neurosurgery 22:386-387, 1988)
Cervical Root Compression by a Traumatic Pseudoaneurysm of the Vertebral Artery: Case Report
Authors: Ross Donald A. , Olsen Walter L. , Van Halbach  , Rosegay Harold , Pitts Lawrence H.
Published: May 2010

We report the case of a patient with cervical monoradiculopathy secondary to a pseudoaneurysm of the vertebral artery caused by a knife wound to the neck. (Neurosurgery 22:414-417, 1988
Conversion of a Lumboperitoneal Shunt to a Lumboatrial Shunt through Femoral Catheterization: Technical Note
Authors: Aoki Nobuhiko
Published: May 2010

A new technique for the diversion of the peritoneal end of a lumboperitoneal shunt into the right atrium through femoral vein catheterization is presented. As an alternative to a ventriculoatrial shunt, this is a promising technique for the treatment of patients with communicating hydrocephalus when the peritoneal cavity is not suitable for placing the distal end of the shunt. (Neurosurgery 22:438-439, 1988)
Patterns of Recurrence in Glioma Patients after Interstitial Irradiation and Chemotherapy: Report of Three Cases
Authors: Heros Deborah O. , Renkens Kenneth , Kasdon David L. , Adelman Lester S.
Published: May 2010

Three patients with malignant gliomas who developed dissemination of tumor at the time of recurrence are presented. All three patients received combination therapy including conventional radiotherapy and interstitial radiation therapy followed by systemic BCNU chemotherapy. A review of the literature on the development of glioma metastases and an analysis of the possible mechanisms of this uncommon growth pattern are presented. (Neurosurgery 22:474-478, 1988)
Aneurysm Surgery in a Community Setting
Authors: Koenig George H.
Published: May 2010

A 15-year surgical experience of 34 aneurysms in private practice is reported. There was 1 death secondary to postoperative arterial spasm, and 3 patients sustained neurological injury. The remaining patients were normal or neurologically stable or improved. Although intracranial aneurysm surgery in a community setting differs from such surgery in a university setting, it seems that similar results can be obtained despite the more limited number of cases encountered. (Neurosurgery 22:501-502, 1988)
Computed Tomographic Diagnosis of Ruptured Giant Posterior Cerebral Artery Aneurysms
Authors: Scott LCDR Brett A. , Weinstein Zelig , Pulliam CDR Morris W.
Published: May 2010

Ruptured giant posterior cerebral artery (PCA) aneurysms are encountered rarely. Although computed tomographic (CT) scan features of giant intracranial aneurysms have been described. CT scan features of acutely ruptured giant saccular PCA aneurysms have not been reported. A case of an acutely ruptured giant saccular PCA aneurysm with diagnostic CT scan features and autopsy confirmation is presented. Two additional cases of apoplexy with identical clinical courses and CT scan appearances, both attributed to giant saccular PCA aneurysms, are described. Diagnostic CT scan features included evidence of intraparenchymal temporal lobe and intraventricular hemorrhage, the presence of a filling defect in the temporal lobe hematoma that enhanced after intravenous contrast administration, and evidence of proximal PCA entrance into the contrast-enhanced filling defect in the intracerebral hematoma. The incidence of PCA aneurysms and the anatomy of the PCA as it relates to these giant aneurysms, their clinical presentation, and diagnostic features of the CT scan are discussed. (Neurosurgery 22:553-558, 1988)
Effective Preoperative Irradiation of Highly Vascular Cerebellopontine Angle Neurinomas
Authors: Ikeda Kiyonobu , Ito Haruhide , Kashihara Kengo , Fujisawa Hirosuke , Yamamoto Shinjoro
Published: May 2010

Three cases of large cerebellopontine angle neurinoma with marked vascularity and tumor staining on the angiogram were treated with effective preoperative irradiation. The radiotherapy was given before the second operation in two cases and before the first operation in the other case. Irradiation doses administered with a linear accelerator were 2.34 to 3.0 Gy for 3 to 3.5 weeks, and radical operations were done 1.5 to 2 months after irradiation. After the irradiation, vertebral angiography showed moderate to marked decrease of the hypervascular capsular stain and disappearance of the early draining vein. Computed tomographic scan showed enlargement of the central necrotic area within the heterogeneously enhanced tumor, which was unchanged in size. Radical operations, which had been impossible because of uncontrollable massive bleeding, were successful without any intraoperative bleeding after radiotherapy. Postirradiation radiological findings corresponded well with those of histopathological examination, which showed decrease in cellularity and in vascularity and diffuse coagulation necrosis around the collapsed tumoral vessels as radiation effects. Preoperative irradiation of the hypervascular neurinoma was thought to facilitate radical surgery by abolishing or diminishing the risk of intraoperative bleeding. (Neurosurgery 22:566-573, 1988)
Computed Tomography and Magnetic Resonance Imaging in Traumatic Locked-In Syndrome
Authors: Zampella Edward J. , Duvall Ernest R. , Langford Keith H.
Published: May 2010

The first reported case of traumatic locked-in syndrome with computed tomographic and magnetic resonance scan confirmation of the brain stem lesion is presented. The lesion responsible for the patient's condition consisted of a hemorrhage in the ventral pontomedullary junction. The pathophysiology of the production of such lesions is discussed. (Neurosurgery 22:591-593, 1988)
Thrombosis of a Giant Aneurysm of the Basilar Artery
Authors: Marchau M.M.B. , Vallaeys J. , Vanhoonen G.
Published: May 2010

Thrombosis of a giant aneurysm of the basilar artery appears on computed tomographic scan as a well-delineated, prepontine, hyperdense mass. (Neurosurgery 22:612-613, 1988)
Surgical Management of Extreme Lateral Lumbar Disc Herniations: Review of 138 Cases
Authors: Abdullah Adel F. , Wolber Paul G. H. , Warfield John R. , Gunadi I. Krist
Published: May 2010

Extreme lateral disc herniations in the authors' series account for 10% of all lumbar herniations; 80% occurred at the L3, L4 and L4, L5 interspaces. The authors review the clinical findings in 138 patients and point to the characteristic features of the clinical syndrome. They compare the accuracy of various diagnostic studies and conclude that computed tomography is highly accurate and should be used before other diagnostic studies. Discography is still helpful as a confirmatory study in some cases, whereas myelography is particularly useful in disclosing other associated lesions. Analysis of the operative series revealed a high percentage of extruded fragments (60%) and a significant number of double herniations on the same side and at the same level (15%). These two findings may respectively preclude chemonucleolysis and microsurgery from the surgical management of extreme lateral herniations. Double herniations explain some discrepancies in the clinical picture and are emphasized as a potential source of error in diagnosis. The surgical technique allows exploration for herniations within the intervertebral canal as well as for extraforaminal herniations without sacrifice of the facet. Operative results are presented.
Feasibility and Efficacy of Preirradiation Chemotherapy for Pediatric Brain Tumors
Authors: Horowitz Marc E. , Kun Larry E. , Mulhern Raymond K. , Kovnar Edward H. , Sanford Robert A. , Hockenberger Beverly M. , Greeson Frances L. , Langston James W. , Fairclough Diane L. , Jenkins Jesse J.
Published: May 2010

Preirradiation chemotherapy is a potentially important component of combined treatment for brain tumors; however, concerns over its side effects and antitumor activity have impeded its evaluation in clinical trials. To determine the feasibility of administering such therapy to children, we assessed the responses of 38 brain tumor patients (median age, 2 years) to 12 weeks of combination chemotherapy given after surgical resection but before irradiation. Transient myelosuppression was noted in all patients, but was not associated with infections or complications of surgical wounds. The ability of the patients to perform activities of daily life, as rated with the Karnofsky performance scale, was either improved (n = 14) or unchanged (n = 18) at the end of the evaluation period. In the remainder of the group, functional deterioration was clearly related to causes other than drug treatment. Prior chemotherapy did not compromise the delivery of radiation except for a brief interruption of spinal irradiation in 3 patients. Objective responses to chemotherapy, defined as a >50% decrease in tumor masses, occurred in 16 of the 31 patients who had subtotal resections; only 6 patients in the entire group showed disease progression during the 12 weeks of drug administration. We conclude that chemotherapy of the type used in this study is well tolerated and produces beneficial effects in children with brain tumors.