bluuebunny/crossref_metadata_2025 huggingface dataset:
Traumatic Aneurysm of the Extracranial Vertebral Artery
Authors: Rahimizadeh Abolfazl , Sabouri-Daylami Manouchehr , Amir-Moezi Naser , Haddadian Karim
Published: May 2010

Aneurysms of the extracranial vertebral artery are rare because of the protection afforded by the bony canal, and the literature contains only a few limited reports on this subject. In the view of its rarity, we present the case of a 20-year-old soldier with a traumatic aneurysm of the vertebral artery at the C-2 level. Because of occlusion of the ipsilateral carotid artery, reconstruction of the vertebral artery by autogenous vein graft was undertaken through a posterior approach; because of inadequate mobilization of the artery, continuity was preserved using aneurysmorrhaphy. The literature is reviewed, and the various treatments are discussed.
Extracranial-Intracranial Bypass Surgery: A Critical Analysis in Light of the International Cooperative Study
Authors: Awad Issam A. , Spetzler Robert F.
Published: May 2010

The ability of extracranial-intracranial bypass surgery to alter favorably the natural history of ischemic cerebrovascular disease remains in question. A recently completed prospective randomized multicenter cooperative trial failed to confirm the hypothesis that the procedure prevents further cerebral ischemia in patients with atherosclerotic internal carotid artery or middle cerebral artery disease. We analyze findings of the study in detail, including possible effects on the natural history of the disease beyond the immediate perioperative period. Potential sources of bias that may have unpredictably affected the study are discussed. These include observational bias (patient and therapist not blinded), “randomization-to-treatment” bias (high morbidity after randomization but before operation), and “prerandomization” or allocation bias (patients in the study representing a selected sample of the population with cerebrovascular disease). The extensive analysis of secondary subgroups with small numbers of patients is discussed in light of the statistical methods used. Two particular classes of patients not addressed in the study who might benefit from the procedure are defined. They are patients failing the best available medical therapy and patients with clearly documented hemodynamic compromise. Possible indications for bypass surgery are suggested for the various lesions in light of the trial and of recent reports on the natural history and pathophysiology of ischemic cerebrovascular disease. Selected cases illustrating these indications are presented.
Models of Spinal Cord Injury: Part 1
Authors: Perry Black , Ronald S. Markowitz , Viraf Cooper , Alan Mechanic , Harvey Kushner , Ivan Damjanov , Sydney D. Finkelstein , Kenneth C. Wachs
Published: May 2010

Testing of potential therapies for spinal cord injury has been significantly hampered by the unavailability of a standardized, reproducible animal model with predictable outcome at a given force of injury (dose-response). The rat was selected in the development of this model in preference to larger animals for economy and availability; this permits use of large numbers of animals to increase statistical validity. In the experiments reported in this article, a static load method (weight placed gently on cord) of inducing cord injury was evaluated. A total of 198 Sprague-Dawley rats were used. Under general anesthesia, a one-level laminectomy was carried out at T-12 with the dura mater intact. Weights varying from 80 to 150 g were lowered onto the dorsal surface of the intact dura mater for durations of 0 to 300 seconds. Recovery of motor function was assessed for up to 8 weeks using two behavioral tests, a modified Tarlov scale and an inclined plane test of hind limb motor function. A statistically significant relationship was found between force of injury and motor recovery as measured by the Tarlov scale, but this did not correlate with inclined plane performance; the duration that the weight rested on the cord did not influence outcome. Pathologically, there was variation in the extent of damage for a given injury load. A semiquantitative pathological assessment of cord injury showed a statistically significant correlation between pathological score and behavioral deficit as measured by the Tarlov scale, but this did not correlate with inclined plane performance. In view of these deficiencies, the static load technique does not seem to be an ideal model for spinal cord injury research.
Sacrococcygeal Rhizotomy for Perineal Pain
Authors: Stephen C. Saris , Jon M. Silver , Jose F. S. Vieira , Blaine S. Nashold
Published: May 2010

Chronic pain in the perineum is a difficult neurosurgical problem. This article evaluates the effectiveness of sacrococcygeal rhizotomy in 28 patients who had cancer-related pain or coccydynia, underwent rhizotomy, and were followed for an average of 3 years. Good pain relief was obtained in 53% (10 of 19 patients) with malignant pain, as opposed to 22% (2 of 9 patients) with nonmalignant pain. Sacral rhizotomy is a reasonable treatment for cancer-related perineal pain, but it is ineffective for coccydynia and other benign perineal pain problems.
Intranasal Schwannoma with Extension into the Intracranial Compartment: Case Report
Authors: John Zovickian , David Barba , John F. Alksne
Published: May 2010

The authors present a case of intranasal schwannoma with extension into the intracranial compartment. Computed tomographic findings are presented, and a combined intranasal and subfrontal operative approach is described. The pathology, origin, and clinical characteristics of intranasal schwannomas are reviewed.
Histiocytosis-X of the Spinal Cord: A Case Report
Authors: Nayef R. F. Al-Rodhan , Ossama Al-Mefty , John T. Godwin , John R. Jinkins , John L. Fox
Published: May 2010

A rare case of histiocytosis-X of the spinal cord with evidence of intramedullary infiltration and epidural spinal cord compression is reported. The clinical, radiological, and histopathological features are discussed, and the pertinent literature is reviewed.
Advances in Genitourinary Neurostimulation
Authors: Schmidt Richard A.
Published: May 2010

The author reviews experience with genitourinary stimulation. Neurostimulation is of most benefit in spastic patients. Experience with sacral root stimulation is discussed. Complete bladder evacuation can be achieved with a combination of selectively placed neurectomies and strategically positioned electrodes.
Primary Myxoma in the Pituitary Fossa: Case Report
Authors: Nagatani Masaaki , Mori Shintaro , Takimoto Noboru , Arita Norio , Ushio Yukitaka , Hayakawa Toru , Gen Moritetsu , Uozumi Tohru , Mogami Heitaro
Published: May 2010

A case of primary myxoma in the pituitary fossa is described. The tumor presented as an intrasellar and suprasellar mass and was successfully removed during a transsphenoidal operation. It was verified as a myxoma by histopathological studies, and there was no evidence that it was a metastasis. This is thought to be the first report of this tumor occurring in the pituitary fossa.
Brain Grafting as a Treatment for Parkinson's Disease
Authors: Perlow Mark J.
Published: May 2010

Parkinson's disease is an illness with neuropathological and neuroanatomical abnormalities in many areas of the central nervous system. Some clinical manifestations of this illness are correlated with pathological changes in the substantia nigra and with a loss of dopamine in the nigra and striatum. The most effective pharmacological treatments have used agents that either replace the lost dopamine or act as agonists on dopamine receptors. Recent studies in animal models of Parkinson's disease demonstrate that the loss of dopamine and many clinical manifestations of dopamine reduction can be reversed by transplantation of fetal dopamine-containing cells to specific dopamine-depleted areas of the brain. Long term viability of these transplants has also been demonstrated. The author suggests that the transplantation of dopamine neurons, even across species barriers, is a reasonable consideration for the treatment of human Parkinson's disease. This article reviews in detail the results of recent experiments and how the experience in these models might be utilized in determining a transplantation strategy for the treatment of specific clinical aspects of this illness.
Ganglioglioma: A Correlative Clinicopathological and Radiological Study of Ten Surgically Treated Cases with Follow-Up
Authors: Kalyan-Raman Uma P. , Olivero William C.
Published: May 2010

Gangliogliomas are rare benign tumors of the central nervous system containing neoplastic ganglion and low grade glial cells. In studying 10 surgically treated cases, we evaluated the clinical, pathological, radiological, and immunocytochemical features, with follow-up. Ranging from 18 to 58 years in age, 7 patients were women, and 3 were men. The most common presenting symptom was seizure. Computed tomographic scan showed a low density enhancing mass in 8 and calcification in 5. Six had minimally abnormal vascularity on angiography. Seven patients had total and 3 had subtotal resections of the tumor. The temporal lobe was the location of the tumor in 6 cases. All of the cases met the histological criteria of Russell and Rubinstein for ganglioglioma. Four patients received postoperative radiotherapy because of subtotal resection or aggressive histological makeup. On follow-up, from 2.5 to 7 years, 8 patients are alive and tumorfree, and 7 are also seizure-free. Two died after operation: one immediately and the other of a glioblastoma that developed 5 years later. Our study confirms that ganglioglioma is a distinct histological entity, anatomically localized, with characteristic clinical and radiological findings and long term survival. Aggressive histological makeup is not a definite indication of malignant potential. The definitive role of follow-up radiotherapy for this tumor needs further study. Malignant evolution is rare, but warrants follow-up.
Radiation Therapy in the Treatment of Partially Resected Meningiomas
Authors: Barbaro Nicholas M. , Gutin Philip H. , Wilson Charles B. , Sheline Glenn E. , Boldrey Edwin B. , Wara William M.
Published: May 2010

To address the question of whether radiation therapy is beneficial in the management of partially resected meningiomas, we reviewed the records of all patients admitted to the University of California, San Francisco, between 1968 and 1978 who had a diagnosis of intracranial meningioma. The patients were divided into three groups: 51 patients had gross total resection and did not receive radiation therapy, 30 patients had subtotal resection and no radiation therapy, and 54 patients had subtotal resection followed by radiation therapy. The subtotal resection groups were similar in average age, male: female ratio, and tumor location, which allowed a valid comparison of the effects of irradiation. The recurrence rate in the total resection group was 4% (2 of 51 patients). Among patients in the subtotal resection groups, 60% of nonirradiated patients had a recurrence, compared with only 32% of the irradiated patients. The median time to recurrence was significantly longer in the irradiated group than in the nonirradiated group (125 vs. 66 months, P < 0.05). There was no complication related to irradiation. These results provide convincing evidence that radiation therapy is beneficial in the treatment of partially resected meningiomas.
Functional Recovery after Decompressive Spine Operation for Cervical Spine Fractures
Authors: Benzel Edward C. , Larson Sanford J.
Published: May 2010

Ninety-nine patients with cervical spine fractures from C-4 through C-7 were operated upon from 1975 to 1981. Operation was performed to restore normal relationships between the spinal cord and roots and the spinal canal and foramina and to maintain these relationships by fusion when necessary. Neurological function was recorded pre- and postoperatively using a functional scale. Satisfactory fusion without adverse change in vertebral alignment was achieved in each patient. The average interval between injury and operation was 29 days. When neurological recovery was observed, it began promptly after operation, suggesting a cause and effect relationship.
Meningioangiomatosis Not Associated with von Recklinghausen's Disease
Authors: Sakaki Saburo , Nakagawa Kou , Nakamura Kou , Takeda Sadanori
Published: May 2010

We report a rare case of meningioangiomatosis unassociated with von Recklinghausen's disease. The patient was a 30-year-old woman with a 25-year history of seizures. The lesion was confined to the right temporal cortex and consisted of a proliferation of angiomatous blood vessels and meningocytic cells. Her seizures have been well controlled after excision of the lesion.
Effect of the Acute Administration of High Dose Pentobarbital on Human Brain Stem Auditory and Median Nerve Somatosensory Evoked Responses
Authors: Drummond John C. , Todd Michael M. , Schubert Armin , Hoi Sang U
Published: May 2010

Brain stem auditory (BAERs) and median nerve somatosensory evoked responses (MnSSERs) were recorded from normal neural pathways during the induction of pentobarbital coma in six patients undergoing elective excision of complex arteriovenous malformations. Each patient received a 33-minute infusion of pentobarbital at a rate of 0.6 mg/kg (total dose. 19.8 mg/kg). This regimen resulted in burst suppression or isoelectricity of the electroencephalogram in all patients. Although statistically significant changes in latency and amplitude occurred, both BAERs and MnSSERs were readily recordable in all patients throughout the infusion. For the BAER, there were significant increases in the latencies of Waves III and V. However, these increases are sufficiently small that misinterpretation of these changes as an evolving neurological injury is unlikely, e.g., Wave V latency increased from 6.25 ± 0.25 (SD) to 6.58 ± 0.16 ms (P < 0.006). For the MnSSER, changes of greater potential clinical relevance were observed. There were substantial increases in the latencies of the early components of the primary cortical response and in the central conduction time (e.g., CCT of 6.1 ± 0.6 ms preinduction vs. 7.7 ± 1.1 ms at t = 33 min, P < 0.003), and the amplitude of the early cortical response (N20-P25) decreased by a mean of 45% (P < 0.02). By contrast, subcortical components of the MnSSER (brachial plexus, upper cervical spine) were only minimally affected. We conclude that, in patients who are initially neurologically intact, BAERs and MnSSERs can be monitored effectively during pentobarbital coma and that the loss of these responses should not be ascribed to the effects of this drug alone. However, the interpretation of evoked response changes, particularly MnSSER changes, that occur during pentobarbital administration should take into account the dose-related changes in latency and amplitude that we have observed.
Cerebral Circulation during Arteriovenous Malformation Operation
Authors: Barnett Gene H. , Little John R. , Ebrahim Zeyd Y. , Jones Stephen C. , Friel Harry T.
Published: May 2010

The circulatory changes in the cortex around a cerebral arteriovenous malformation (AVM) were studied in 18 patients. The AVMs had rapid circulation times with early draining veins on angiography. Local cortical blood flow (ICoBF) was measured with cortically applied thermister/Peltier stack arrays. The AVMs had a more pronounced effect on ICoBF at a 2- to 4-cm distance from the AVM margin than in the adjacent cortex. Mean preexcision ICoBF was 62.9 ± 6.7 (SE) ml/100 g/minute (i.e., similar to normal controls) near the AVM margin and 43.0 ± 4.2 ml/100 g/minute far (i.e., >2 cm) from the AVM. CO2 reactivity (COR) before excision was 1.1 ± 0.3 ml/100 g/minute/torr of CO2 (i.e., similar to normal controls) at near sites and 0.6 ± 0.3 ml/100 g/minute/torr of CO2 at far sites. The mean postexcision near ICoBF remained stable at 55.8 ± 5.1 ml/100 g/minute at near sites, but the far ICoBF significantly increased (P < 0.05) to 57.2 ± 6.8 ml/100 g/minute. The cortical feeding artery pressure was substantially below the normal cortical artery pressure in 50% of the cases studied. Pressure in these arteries normalized after occlusion and AVM excision, resulting in a rapid increase in cortical artery perfusion pressure. Draining red vein pressure, which was elevated before AVM excision, also dropped after excision, contributing to the increase in perfusion pressure. Two patients who developed the normal perfusion pressure breakthrough syndrome (PBS) after operation had low ICoBF and disturbed COR before AVM excision and marked increase of ICoBF after excision. Factors that contribute to the development of PBS include: (a) low ICoBF around an AVM; (b) impaired COR; (c) low cortical artery pressure before AVM excision; (d) normalization in cortical artery pressure after AVM removal; and (e) substantial increase in ICoBF after AVM removal. Maintenance of a low systemic arterial blood pressure during the early postoperative period is essential in reducing the risk of severe cerebral edema.
Incidence and Management of Complications of Transsphenoidal Operation for Pituitary Adenomas
Authors: Black Peter McL. , Zervas Nicholas T. , Candia Guillermo L.
Published: May 2010

Two hundred fifty-five consecutive transsphenoidal procedures for pituitary adenomas were reviewed to evaluate complications and their management. There were no operative deaths. Cerebrospinal fluid (CSF) rhinorrhea was the most common complication, occurring in 2.7% of cases; diabetes insipidus was next, lasting less than 1 year in 1.6% of patients and over a year in 0.4%. Sinusitis occurred in 1.2% of patients, and delayed epistaxis occurred in 0.8%. Postoperative hematomas, meningitis, hydrocephalus, and deep venous thrombosis each occurred in 0.4% of cases. These results are discussed in the context of previous reports, including an international survey of pituitary surgeons. Although transsphenoidal surgery has a low morbidity and mortality, it is nevertheless associated with potentially serious difficulties that should be expeditiously recognized and managed.
Glioblastoma after Radiotherapy for Craniopharyngioma: Case Report
Authors: Ushio Yukitaka , Arita Norio , Yoshimine Toshiki , Nagatani Masaaki , Mogami Heitaro
Published: May 2010

A 6-year-old girl developed a glioblastoma in the basal ganglia and brain stem 5 years after surgical excision and local irradiation (5460 cGy) for craniopharyngioma. Clinical and histological details are presented, and the literature on radiation-induced gliomas is reviewed. (Neurosurgery 21: 33-38, 1987)
Craniosynostosis and Hydrocephalus
Authors: Golabi Mahin , Edwards Michael S. B. , Ousterhout Douglas K.
Published: May 2010

Ten cases of craniosynostosis associated with hydrocephalus were found in a retrospective review of 250 cases of children with craniosynostosis. Four children had Pfeiffer's syndrome, 3 had Crouzon's syndrome, 2 had kleeblattschädel with multiple anomalies and therefore could not be classified into a definite syndrome, and 1 had isolated sagittal synostosis. Of these 10 children, 5 had kleeblattschädel, two with Crouzon's syndrome, one with Pfeiffer's syndrome, and 2 with multiple anomalies. In all patients, hydrocephalus was controlled by a shunting procedure. Possible causes of hydrocephalus in association with craniosynostosis are discussed. (Neurosurgery 21: 63-67, 1987)
Malignant Nerve Sheath Tumor of the Facial Nerve: Case Report and Discussion
Authors: Muhlbauer Michael S. , Clark Craig W. , Robertson Jon H. , Gardner Gale L. , Dohan Curtis F.
Published: May 2010

The third reported case of a malignant nerve sheath tumor of the facial nerve is presented. The clinical course and pathological findings are described and serve as the basis for a discussion concerning malignant nerve sheath tumors arising in the cranial nerves. (Neurosurgery 21: 68-73, 1987)
Common Carotid Occlusion for Unclippable Carotid Aneurysms: An Old but Still Effective Operation
Authors: Swearingen Brooke , Heros Roberto C.
Published: May 2010

We present a selected series of nine patients with unclippable internal carotid artery aneurysms to illustrate our current approach to this problem. Eight of the nine underwent common carotid ligation after preoperative angiographic evaluation. Tolerance to carotid occlusion was determined intraoperatively by awake examination, electroencephalogram (EEG) monitoring, and carotid stump pressure measurements. No patient developed a permanent deficit; seven of eight treated aneurysms have thrombosed. Our experience and review of the literature indicate that most ischemic complications after carotid ligation seem to be thromboembolic, rather than due to “low flow” from poor collateral circulation. For this reason, we have gradually come to favor common carotid (CCA) over internal carotid (ICA) occlusion in many of these patients. After CCA occlusion, the ICA frequently remains open and embolic complications are therefore less likely. An extracranial-intracranial bypass procedure is performed only in those patients with poor collateral circulation demonstrated by cross compression angiographic studies, by the development of new deficits during test occlusion, or by the appearance of EEG changes during test occlusion. We suggest that CCA ligation remains a useful alternative in the management of unclippable internal carotid aneurysms.
Computed Tomography-guided Stereotactic Aspiration of Posterior Fossa Hematomas: A Supine Lateral Retromastoid Approach
Authors: Niizuma Hiroshi , Suzuki Jiro
Published: May 2010

We report a supine lateral retromastoid approach for computed tomography-guided stereotactic aspiration of hematomas of the posterior fossa. The method involves horizontal insertion of the aspiration needle at the suboccipital region with the patient in a supine position with the head turned 30 to 40° away from the lesion and with slight forward flexion of the neck. Eleven hematomas have been removed through this approach thus far, nine cerebellar and two pontine. With this technique, general anesthesia is not needed and operative invasion is minimal, allowing hematoma aspiration in patients in whom operation would previously not have been indicated. An additional merit is the suitability of this method for elderly patients.
Long Term Intrathecal Administration of Morphine: A Comparison of Bolus Injection via Reservoir with Continuous Infusion by Implanted Pump
Authors: Brazenor Graeme Alexander
Published: May 2010

Twenty-six cases of chronic intrathecal morphine administration are described: 19 cases utilizing the Spinalgesic injectable subcutaneous reservoir and 7 cases utilizing the Infusaid implanted infusion pump. In 25 cases, the morphine was delivered into the spinal subarachnoid space, and in 1 case of thalamic pain it was delivered into the temporal horn of the ipsilateral cerebral ventricle. The average duration of usage of the system was 132 days. The efficacy of the method was excellent: 23 of 26 patients used no other analgesics or only minor ones such as aspirin, paracetamol, or dextropropoxyphene. The complication rate was low, with no infections under the author's care, and only 4 catheter blockages (1 by tumor). There have been no complications in the 7 patients with implanted pumps. From this experience, the author concludes that the implanted pump is now the method of choice in all patients who can afford it and for whom the life expectancy outside an institution is in excess of 60 days. A special and relatively absolute indication for the pump is the situation of pain in the arm, head, or neck areas, in which case the constant morphine levels likely to be achieved with the pump may prevent failure of the method due to intractable nausea or emesis. The subcutaneous reservoir is otherwise to be preferred if the patient's disease is progressing rapidly, if the patient is already institutionalized and likely to remain so, or where the cost of the implanted pump would cause hardship. Either method of delivery of morphine to the subarachnoid space can provide incomparable analgesia without clouding of consciousness, with a very low complication rate. (Neurosurgery 21:484-491, 1987)
Clinicopathological Relations of Cerebral Cavernous Angiomas: Observations in Eleven Cases
Authors: Steiger Hans J. , Markwalder Thomas M. , Reulen Hans-J.
Published: May 2010

Eleven cases of cerebral cavernous angiomas (cavernomas) were observed within a period of 3 years. Two patients presented with cerebral hemorrhage, five with epilepsy, three each with a progressive focal neurological deficit, and one with papilledema. The unruptured lesions had a heterogeneous density on computed tomography with relatively little contrast enhancement. Two lesions contained major cysts. In one of these cases, the cyst measured 5.5 cm in diameter, had an enhancing membrane, and was surrounded by brain edema. Angiography did not show hypervascularity in any instance. During exploration and histological processing, special attention was paid to signs of previous silent hemorrhages and to the degree of encapsulation of the lesion. Iron deposits (signs of previous hemorrhages) were seen to varying degrees inside all cavernomas as well as in the surrounding gliotic cerebrum, and a causal relation between iron deposits and epileptic seizures seems likely. Encapsulation was minimal with the ruptured cavernomas and particularly prominent with the cystic lesions. The membrane of the giant cystic lesion with peripheral brain edema had a histological structure similar to that of the membranes of chronic subdural hematomas. It is suggested that continuous growth of cavernoma cysts is the result of recurrent hemorrhages from sinusoids of the malformation and from the neocapillary network of the cyst membranes.
Metastatic Tumor of the Pituitary Gland
Authors: Nelson Paul B. , Robinson Alan G. , Martinez Julio A.
Published: May 2010

Although metastatic tumors of the pituitary gland and the sellar region are not common, they may radiographically mimic a pituitary tumor. Because the metastasis frequently involves the posterior lobe and because lateral extension to the cavernous sinus is common, patients may present with ptosis, diplopia, or diabetes insipidus. Decrease in anterior pituitary function is less common. Metastatic tumors contain abundant vascular networks, as evidenced by frequent blush on cerebral angiography and increased bleeding at operation. We report the case of a 57-year-old woman who presented with rapid onset of bilateral ptosis and ophthalmoplegia and was found to have a metastatic carcinoma within the pituitary gland.
Dorsal Root Entry Zone Lesions for the Treatment of Brachial Plexus Avulsion Injuries: A Follow-up Study
Authors: Friedman Allan H. , Nashold Blaine S. , Bronec Peter R.
Published: May 2010

Dorsal root entry zone (DREZ) lesions have been shown to yield short term relief from the pain associated with a brachial plexus avulsion injury. Because of the propensity of pain to recur after neuroablative procedures, 39 patients with pain after a brachial plexus avulsion injury were observed for 14 months to 10 years after DREZ lesions were made. Fifty-four per cent of these patients were afforded good pain relief. Of 21 patients who had multiple small lesions made within the DREZ, 15 (72%) were afforded good pain relief. (Neurosurgery 22:369-373, 1988)
Ambulatory Microsurgery for Ruptured Lumbar Discs: Report of Ten Cases
Authors: Cares Herbert L. , Steinberg Robert S. , Robertson Edgar T. , Caldini Paolo
Published: May 2010

Advances in microsurgical techniques combined with a widening interest in same-day surgery led us to investigate ambulatory lumbar discectomy. We could find no precedent in the literature. Ten patients with classic ruptured lumbar discs confirmed by computed tomography chose to participate. They were aged 31 to 51, seven men and three women, in excellent general health. A microsurgical approach through a 25-mm skin incision was performed. The technique emphasized removal of suffiient medial facet to allow excision of the disc with minimal or no root retraction. Once awake in the recovery room, patients were transferred to a separate ambulatory step-down unit. They were discharged only after they had voided, ambulated, taken oral nourishment, and been examined by the surgeon. A visiting nurse checked the patient at home the evening of operation and the next day. All returned to their usual occupation between 3 and 14 days postoperatively. All were satisfied and would choose the outpatient program again. Our experience indicates that ambulatory lumbar microdiscectomy can be a safe, effective option for selected patients. (Neurosurgery 22:523-526, 1988)
Giant Aneurysm Arising from the Anterior Cerebral Artery and Causing an Isolated Homonymous Hemianopsia
Authors: Versavel Mark , Witmer Jan P. , Matricali Bart
Published: May 2010

A case of a giant aneurysm arising from the anterior cerebral artery and producing a left homonymous hemianopsia is presented. The aneurysm caused lateral compression of the posterior part of the optic chiasm. After preoperative dynamic assessment of the circle of Willis by angiography and by electroencephalographic recording during carotid artery compression, the aneurysm was trapped with microclips on the anterior cerebral artery proximal and distal to it. Visual field examination 6 months postoperatively showed complete visual field recovery. This is the first case of homonymous hemianopsia caused by an angiographically proven giant aneurysm of the ACA. (Neurosurgery 22:560-563, 1988)
Partially Thrombosed Aneurysm Presenting as the Sudden Onset of Bitemporal Hemianopsia
Authors: Aoki Nobuhiko
Published: May 2010

A case is presented in which the sudden onset of bitemporal hemianopsia was caused by partial thrombosis associated with enlargement of an unruptured anterior communicating artery aneurysm. The features of the sequential computed tomographic scans resembled those of pituitary apoplexy, reemphasizing the necessity for cerebral angiography in preoperative evaluation. The clinical significance of the warning signs of cerebral aneurysm during the era of computed tomography is discussed. (Neurosurgery 22:564-566, 1988)
Radicular Compression Due to Lumbar Intraspinal Gas Pseudocyst: Case Report
Authors: Demierre Bertrand , Ramadan Aymen , Hauser Hermann , Reverdin Alain , Rilliet Bénédict , Berney Jean
Published: May 2010

A case of sciatic pain syndrome is reported. Computed tomography showed evidence of gas in the spinal canal, and at operation a gas-filled pseudocyst was found in the spinal canal, without herniated disc. The cause of this unique case is discussed in relation to the spinal vacuum phenomenon.
Segmental Spinal Dysgenesis
Authors: Scott R. Michael , Wolpert Samuel M. , Bartoshesky Louis E. , Zimbler Seymour , Karlin Lawrence
Published: May 2010

Segmental spinal dysgenesis is characterized by focal agenesis or dysgenesis of the lumbar or thoracolumbar spine, with focal abnormality of the underlying spinal cord and nerve roots. Children are symptomatic at birth with lower limb deformities and neurological deficits that may be segmental. Myelography and computed tomography disclose hypoplastic or absent vertebrae and atrophic or absent neural elements adjacent to the bony deformity; the spinal column distal to the abnormality may be partially bifid, but is otherwise normal. Spinal ultrasonography was a helpful diagnostic adjunct in one patient. Surgery may be helpful in decompressing partially functioning spinal cord or nerve roots, but may exaggerate the tendency toward spinal instability. The embryology of this abnormality is not clear, but two children had other anomalies suggesting a spinal dysraphic syndrome, and its cause is probably related to a segmental maldevelopment of the neural tube.
Middle Cerebral Artery Aneurysm Due to Nocardia asteroides: Case Report of Aneurysm Excision and Extracranial-Intracranial Bypass
Authors: Hadley Mark N. , Spetzler Robert F. , Martin Neil A. , Johnson Peter C.
Published: May 2010

Nocardia asteroides is an uncommon human pathogen typically encountered in immunocompromised patients. Primary central nervous system (CNS) nocardiosis is rare and usually manifests as cerebritis or abscesses. The case of a young woman who presented with CNS Nocardia abscesses complicated by an infective middle cerebral artery aneurysm is reported. Treatment, which included abscess aspiration, aneurysm excision, and end-to-end extracranial to intracranial bypass and prolonged antibiotic therapy, resulted in an excellent outcome. This case and the management of CNS nocardiosis are reviewed.
Scalp and Calvarial Masses of Infants and Children
Authors: Ruge John R. , Tomita Tadanori , Naidich Thomas P. , Hahn Yoon S. , McLone David G.
Published: May 2010

Review of 70 children presenting with a solitary nontraumatic lump on the head revealed that 61% ofthe lesions were dermoid tumor, 9% were cephalhematoma deformans, 1% were eosinophilic granuloma, and 4% were occult menin goceles and encephaloceles. Most of the dermoid cysts occurred along sutural lines, but some did not. One of the eosinophilic granulomas was located over the sagittal suture. Seventeen per cent of the “lumps” had significant intracranial extension. An additional 20% of the lumps extended intracranially, but only to the dura mater. Work-up of these lesions should include initial plain skull roentgenograms to assess multiplicity and appropriate computed tomographic scans to assess possible intracranial extension.
Multilevel Lumbar Laminotomies for Focal Spinal Stenosis: Case Report
Authors: Aryanpur John , Ducker Thomas
Published: May 2010

We describe a case of spondylotic lumbar spinal stenosis in an infirm elderly patient successfully treated with multilevel laminotomies. This procedure is less stressful to patients than a full laminectomy. In a selected subgroup of patients with “hourglass” spondylotic stenosis, it may provide adequate decompression.
Intracytoplasmic Lumina in Meningioma: An Ultrastructural and Immunohistological Study
Authors: Vakili Saeed T. , Muller Jans
Published: May 2010

Three surgically removed meningotheliomatous meningiomas with hyaline inclusions or pseudopsammoma bodies were studied. Ultrastructurally, the lumina seemed to be predominantly intracytoplasmic, defined by a systemic unit membrane; they displayed abundant microvilli and contained granular or filamentous material, vacuoles, vesicular bodies, and lamellar structures. The cytoplasm surrounding the intracytoplasmic lumina was electron-dense and contained tonofilments and desmosomal junctions. All three meningiomas showed expression of carcinoembryonic antigen, cytokeratin, and epithelial membrane antigen in the cells surrounding the hyaline bodies. Keratin, α-1-antitrypsin, and immunoglobulin M showed weak positive staining. There was widespread vimentin except in the cells with hyaline inclusions. Glial fibrillary acidic protein and S100 were negative. These results provide additional confirmation of immunohistochemical data that can serve as evidence for epithelial and secretory differentiation in meningiomas.
Treatment of Scaphocephaly with Sagittal Craniectomy and Biparietal Morcellation
Authors: Greene Clarence S. , Winston Ken R.
Published: May 2010

A series of 50 consecutive patients with scaphocephaly treated by a new operation are reported, and the results are reviewed in detail. The treatment consists of a broad sagittal craniectomy plus extensive morcellation of both parietal bones and, occasionally, the squamous portion of the occipital bone, without dislodging the bony fragments from their dural attachments. The procedure can be done relatively rapidly (median operative time = 55 min) and with minimal loss of blood (median transfusion = 85 ml). The results are analyzed by several criteria and are considered to be excellent.
Microsurgical Removal of Arteriovenous Malformations of the Basal Ganglia
Authors: Malik Ghaus M. , Umansky Felix , Patel Suresh , Ausman James I.
Published: May 2010

Arteriovenous malformations in the basal ganglia region have been a problem in neurosurgical practice. We report six cases of deep-seated malformations fed mainly by the perforating branches of the middle cerebral artery. There were no deaths in the series. Four patients returned to their previous activities, and the other two patients had persistent hemiparesis and dysphasia, present preoperatively, with worsening in one case. Both of these patients improved and are independent. We show the feasibility of satisfactory microsurgical treatment of these lesions based on the knowledge of microanatomical studies.
Posttraumatic Dissecting Aneurysm of the Anterior Cerebral Artery: Case Report
Authors: Amagasa Masaharu , Sato So , Otabe Kazunori
Published: May 2010

A case of cerebral infarction in the territory of the anterior cerebral artery after a minor head injury is reported. It is possible that direct or mechanical damage by the edge of the falx or stretching and shearing of the anterior cerebral artery after an acute shift of the corpus callosum caused the localized lesion of the left anterior cerebral artery. We think that this mechanical injury caused a dissecting aneurysm or a cerebral arterial dissection, which was diagnosed by sequential angiographic changes.
Midline Lumbar Ganglion/Synovial Cyst Mimicking an Epidural Tumor: Case Report and Review of Pathogenesis
Authors: Azzam Charles J.
Published: May 2010

A case of a midline lumbar extradural ganglion/synovial cyst causing lumbar canal stenosis and mimicking an epidural tumor is presented. The lesion was demonstrated by a magnetic resonance imaging study, and relief of symptoms was achieved with decompressive laminectomy and total removal of the mass. The pathogenesis of lumbar ganglion/synovial cyst is reviewed.
Stab Wounds to the Temporal Fossa
Authors: Haworth C. S. , de Villiers J. C.
Published: May 2010

Stab wounds to the temporal fossa appear as a characteristic clinical entity. Patients admitted with stab wounds to the head during the period 1970 to 1986 were reviewed retrospectively. Of these, 10 met the criteria of having suffered a stab wound that penetrated the skull and dura mater of the temporal fossa. Injury to the internal carotid artery-cavernous sinus complex (3 patients) or to the basilar artery-pons region (5 patients) was frequent. Two other patients experienced injury to the trigeminal nerve and the petrous ridge. The mechanical, neurological, radiological, and prognostic features of knife wounds to this region are discussed.
Transcranial Stab Wounds: A Report of Three Cases and Suggestions for Management
Authors: Herring Carl J. , Lumsden Alan B. , Tindall Suzie C.
Published: May 2010

Transcranial stab wounds are uncommon. Three such cases are presented. The severity of the wounds may vary from innocuous to devastating. Skull films are useful in delineating the depth of penetration. The presence of the knife blade in situ may make the computed tomographic scan impossible to perform or difficult to interpret. Cerebral angiography may be indicated if injury to a major cerebral vessel is suspected or if the patient suffers a delayed subarachnoid or intracerebral hemorrhage. Provided that the patient's clinical status indicates a positive prognosis, transcranial stab wounds should be explored surgically. The weapon should be removed in the operating room immediately before or at the time of operation.
Trigeminal Depressor Response during Percutaneous Microcompression of the Trigeminal Ganglion for Trigeminal Neuralgia
Authors: Brown Jeffrey A. , Preul Mark C.
Published: May 2010

Percutaneous microcompression of the trigeminal ganglion for trigeminal neuralgia was performed 23 times on 21 patients. Significant abrupt drops in heart rate and blood pressure (P < 0.0002) occurred when the needle entered the foramen ovale or upon balloon advancement or inflation. In 16 of 23 (70%) procedures, the heart rate fell abruptly to 60 or less, by a mean of 38%. Mean arterial blood pressure decreased transiently by 31% during 12 of 23 (55%) procedures. Our findings of transient bradycardia and hypotension upon mechanical stimulation or compression of the mandibular nerve or trigeminal ganglion show for the first time the presence of a trigeminal depressor response in humans. We recommend that heart rate and arterial blood pressure be monitored continuously during percutaneous microcompression of the trigeminal ganglion. Intravenous atropine should be available for immediate use, and an external pacemaker should be fitted preoperatively.
Spontaneous Remission of Paralysis Due to Spinal Extradural Hematoma: Case Report
Authors: Emery D. J. , Cochrane D. D.
Published: May 2010

Spontaneous spinal extradural hematoma is an uncommon cause of cord compression and paraplegia. The clinical presentation of this entity is uniform, with sudden pain followed by sensory and motor dysfunction. Unlike other considerations in the differential diagnosis of cord compression, here the pain and clinical deficit may remit suddenly and spontaneously. This feature may obscure the diagnosis of an organic cause for cord dysfunction. This report describes a patient whose extradural hematoma was caused by hemorrhage from an arteriovenous malformation. Dramatic reduction of his pain and paralysis followed myelography.
Surgery of Petroclival Meningiomas: Report of 24 Cases
Authors: Samii Madjid , Ammirati Mario , Mahran Ahmed , Bini Walter , Sepehrnia Abholgasse
Published: May 2010

Twenty-four patients with petroclival meningiomas were operated upon at the neurosurgical clinic of the City Hospital of Hannover between 1978 and 1987. Seventeen were women and seven men; the mean age was 45 years. Symptoms were usually present for more than 2 years before the diagnosis was made. The most common symptom was disturbance of gait; the most common preoperative sign was cranial nerve deficit, mainly of the 7th and 8th nerves. Preoperative neuroradiological evaluation included computed tomography and four-vessel cerebral angiography. Fifteen patients (62%) had a tumor larger than 2.5 cm in its major diameter. The surgical approaches used were the retromastoid, pterional, subtemporal, and combined retromastoid-subtemporal. We developed a modification of the retromastoid-subtemporal approach with preservation of the transverse sinus and used this in the last 2 patients. There was no postoperative death; 11 patients (46%) suffered postoperative complications, mainly in the form of cranial nerve deficits, often reversible. “Total” tumor removal was achieved in 17 patients (71%). Twenty patients (83%) were independent at the time of discharge from the hospital. With accurate neuroradiological evaluation, careful choice of the surgical approach, and sound application of microsurgical techniques, petroclival meningiomas may be “totally” and safely resected in a significant number of patients.
Histiocytosis X of the Hypothalamus
Authors: Ober K. Patrick , Alexander Eben , Challa Venkata R. , Ferree Carolyn , Elster Allen
Published: May 2010

An 18-year-old woman presented with visual disturbance and endocrine dysfunction (diabetes insipidus, delayed puberty, hypothyroidism, hypoadrenalism, and hyperprolactinemia). Computed tomography and enhanced cisternography showed a single hypothalamic mass, which proved at biopsy to be histiocytosis X. Further studies showed the disease to be restricted to the hypothalamus. The patient was treated with hormonal replacement therapy, but her visual acuity continued to worsen. Visual acuity improved after low-dose irradiation of the pituitary fossa and hypothalamus, which also led to disappearance of the mass. This case shows that localized hypothalamic histiocytosis X can be diagnosed and treated successfully before other systems become involved.
Spinal Cord Compression: A Complication of Silicone-Coated Dacron Dural Grafts. Report of Two Cases
Authors: Gomez Heldo , Little John R.
Published: May 2010

Two case reports of compression of the cervical spinal cord associated with silicone-coated Dacron dural grafts are presented. In both cases, the cervical spinal cord was distorted and compressed by an intense tissue reaction that encapsulated the synthetic graft. At least two factors are thought to play a role in precipitating this reaction: (1) the introduction of surface contaminants into the wound, and (2) repeated motion at the graft site.
Stereotactic Radiosurgery of the Brain Using the First United States 201 Cobalt-60 Source Gamma Knife
Authors: Lunsford L. Dade , Flickinger John , Lindner Glenn , Maitz Ann
Published: May 2010

The first United States 201 cobalt-60 source gamma knife for stereotactic radiosurgery of brain tumors and arteriovenous malformations became operational at the University of Pittsburgh on August 14, 1987. Four and one-half years of intensive planning, regulatory agency review, and analysis of published results preceded the first radiosurgical procedure. Installation of this 18,000-kg device and loading of the 201 cobalt-60 sources posed major challenges in engineering, architecture, and radiophysics. In the first 4 months of operation, we treated 52 patients (29 with arteriovenous malformations, 19 with extra-axial neoplasms of the skull base, and 4 with intra-axial malignant tumors). Most patients either had lesions considered “inoperable” or had residual lesions after attempted surgical resection. Neither surgical mortality nor significant morbidity was associated with gamma knife radiosurgery. As compared with treatment by conventional intracranial surgery (craniotomy), the average length of stay for radiosurgery was reduced by 4 to 14 days, and hospital charges were reduced by as much as 65%. Based on both the previously published results of treatment of more than 2,000 patients worldwide and on our initial clinical experience, we believe that gamma knife stereotactic radiosurgery is a therapeutically effective and economically sound alternative to more conventional neurosurgical procedures, in selected cases.
Critical Analysis of Extensive Cervical Laminectomy
Authors: Ishida Yoshihiro , Suzuki Kazuhiro , Ohmori Kazuo , Kikata Yoji , Hattori Yoshiaki
Published: May 2010

Conventional extensive laminectomy has been widely performed to reduce spinal cord compression, and is greatly facilitated by the use of an air drill. Laminectomy is recognized, however, as the occasional cause of problems after surgery, such as spinal instability or deformity, acceleration of spondylotic change, constriction of the dura mater caused by extradural scar formation, and lack of posterior bony protection for the spinal cord. In an effort to eliminate these negative aspects of conventional laminectomy, a surgical technique called suspension laminotomy has been used. Fiftyfive patients treated with conventional extensive laminectomy and 55 others treated with suspension laminotomy were followed up clinically and compared. Flexibility and alignment of the cervical spine were assessed by plane radiographs, and dural configuration by computed tomographic scans. Neurologic improvement was also evaluated. Decrease of spinal movement after laminectomy was observed, notably during extension, probably as a result of functional insufficiency of paraspinal muscles. The incidence of postoperative spinal deformity was lower and the relief of dural constriction better in the patients treated with suspension laminotomy than in those treated with conventional laminectomy. Neurological recovery was significantly better in fully decompressed cases than in insufficiently decompressed cases.