bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of acute spinal cord compression injury on regional spinal cord blood flow in primates
Authors: Sandler Alan N. , Tator Charles H.
Published: May 2009

✓ Spinal cord blood flow (SCBF) was measured in 24 rhesus monkeys after injury to the cord produced by the inflatable circumferential extradural cuff technique. Measurement of regional blood flow in the white and gray matter of the cord in areas of 0.1 sq mm was achieved with the 14C-antipyrine autoradiographic technique and a scanning microscope photometer. After moderate cord injury (400 mm Hg pressure in the cuff maintained for 5 minutes), which produced paraplegia in 50% of animals and moderate to severe paresis in the other 50%, mean white matter SCBF was significantly decreased for up to 1 hour. White matter blood flow then rose to normal levels by 6 hours posttrauma and was significantly increased by 24 hours posttrauma. Gray matter SCBF was significantly decreased for the entire 24-hour period post-trauma. After severe cord injury (150 mm Hg pressure in the cuff maintained for 3 hours), which produced total paraplegia in almost all animals, SCBF in white and gray matter was reduced to extremely low levels for 24 hours posttrauma. In addition, focal decreases in SCBF were seen in white and gray matter for considerable distances proximal and distal to the injury site. It is concluded that acute compression injury of the spinal cord is associated with long-lasting ischemia in the cord that increases in severity with the degree of injury.
Cerebellar glioblastoma in childhood
Authors: Fresh C. Babson , Takei Yoshio , O'Brien Mark S.
Published: May 2009

✓ Ten childhood cerebellar glioblastomas have been reported previously in the world literature. The authors report a case arising de novo in a 9-year-old child and stress the rarity of this tumor.
Brain abscess caused by Salmonella typhi
Authors: Suzuki Yasuo , Sugiyama Yoshiaki , Ishii Ryoji , Sato Isami
Published: May 2009

✓ The authors report a rare case of a brain abscess associated with osteomyelitis caused by Salmonella typhi that remained in contact with human tissues for 33 years without losing its virulence.
Complications of halo-pelvic traction
Authors: Rozario Rodney A. , Stein Bennett M.
Published: May 2009

✓ When halo-pelvic traction is applied at a rapid rate it may induce cranial nerve palsies. The sixth, ninth, and tenth cranial nerves appear to be the most vulnerable. A proposed etiology is the stretching of these nerves resulting in a compromised blood supply with a consequent temporary paralysis which usually improves within 8 to 10 weeks.
Role of pressure gradients and bulk flow in dynamics of vasogenic brain edema
Authors: Reulen Hans J. , Graham Robert , Spatz Maria , Klatzo Igor
Published: May 2009

✓ The authors present the results of an investigation of the vasogenic type of brain edema using cold injury in cats as a model. Their findings indicate that bulk flow and not diffusion should be considered the main mechanism for the spread of edema through the white matter. This conclusion is based on: 1) comparison of the distances actually traveled by various substances during edema spread with those calculated theoretically for migration of the substances by diffusion; 2) coincidence in the speed of movement by two substances (sucrose and albumin) with widely different diffusion coefficients; 3) measurement of interstitial fluid pressure (IFP) at various distances from the lesion showing the presence of increased IFP in the lesion area and decreasing pressures along the edema pathway toward the normal tissue; and 4) the fact that spreading of edema can be significantly impeded by inducing before the cold lesion an intracellular type of brain edema that reduces the size of the extracellular space (ECS) and increases the resistance to flow of edema fluid. The pressure-volume curve of the brain ECS, as derived from determinations of IFP and tissue water content, indicates that an initial steep slope in IFP probably represents the high resistance to fluid mobility through the small diameter extracellular channels and the counteracting resistance of the intermingled structures of brain parenchyma to be separated. Once the IFP exceeds these opposing forces, the ECS dilates, fluid mobility increases, and the edema front advances.
Influence of systemic and cerebral vascular factors on the cerebrospinal fluid pulse waves
Authors: Hamer Jürgen , Alberti Ekhart , Hoyer Siegfried , Wiedemann Klaus
Published: May 2009

✓ In anesthetized, artificially ventilated dogs, the intracranial cerebrospinal fluid (CSF) pulse waves were studied simultaneously with the central aortic pressure, central venous pressure (CVP), and the sagittal sinus pressure under physiological conditions and in normovolemic arterial hypotension and hypertension, in acute cardiac insufficiency of the right atrium, in raised intracranial pressure (ICP), and in arterial hypoxemia. The physiological CSF pulsations are shown to be mainly arterial in origin. In the diastolic phase, the descending part of the pulse curve can be modified by venous superpositions coinciding with the right atrial “A” wave. With increase of ICP the configuration of the CSF pulsations changes: the venous superpositions disappear and the waves become more and more arterial in shape. Furthermore, the pulse amplitude increases considerably. The same change can be observed when cerebral vessels are dilated by arterial hypoxemia. During cardiac insufficiency and consecutive increase of CVP, the CSF pulse curve is venous in shape and the right atrial “A” wave predominates. In arterial hypotension, CSF pressure decreased. Conversely, in angiotensin-induced systemic arterial hypertension, CSF pressure and its pulse amplitude increased. It is concluded that both systemic arterial blood pressure and cerebrovascular reactivity are major determinants for the shape and the pressure amplitude of the intracranial CSF pulse waves. In the presence of cerebral vasodilatation, systemic arterial blood pressure may be an important factor in raising ICP and altering the brain tissue compliance, because cerebral vascular damping of the arterial pulse is diminished and the arterial pressure head may be directly transmitted to the cerebral capillary bed.
Management of hydrocephalus secondary to posterior fossa tumors
Authors: Albright Leland , Reigel Donald H.
Published: May 2009

✓ The records of children with hydrocephalus secondary to posterior fossa tumors were reviewed and the methods of treatment compared with their subsequent clinical course. Of 86 patients evaluated, 47 had no treatment for hydrocephalus prior to tumor removal, 12 had external ventricular drainage, and 27 had cerebrospinal fluid (CSF) shunts before suboccipital craniectomy. Children with CSF shunts before tumor removal had significantly better postoperative conditions than the children without shunts (p < 0.01). Operative mortality of children without treatment of hydrocephalus before tumor surgery was 12.8%; it was 3.7% in the children with preexisting shunts. Treatment of hydrocephalus with a CSF shunt prior to suboccipital craniectomy was a safe procedure that significantly lowered the morbidity and mortality of subsequent tumor removal.
Medulloblastoma in children
Authors: Mealey John , Hall Peter V.
Published: May 2009

✓ The authors review treatment and results in 45 cases of medulloblastoma arising in childhood. The surgical mortality rate observed was 11%. Of those completing postoperative cerebrospinal irradiation at this institution, 53% have survived for 3 years, 41% for 5 years, and 22% for 10 years. The extent of surgical resection of the cerebellar tumor had no significant bearing on the prognosis. Those cases remaining free of recurrent disease had received significantly higher doses of postoperative irradiation, approaching 5000 rads to the whole brain or posterior fossa and 4000 rads to the spinal axis. Repeat irradiation and chemotherapy (vincristine, the nitrosoureas, and methotrexate) provided good palliation in most cases and significantly extended the survival time. However, 28 of 29 patients who developed locally recurrent or metastatic disease have died. Vincristine was considered the chemotherapeutic drug of choice and in 14 cases its use was associated with remissions lasting 2 to 18 months. The combination of chemotherapy and repeat irradiation was followed by remissions of longer duration compared to retreatment by irradiation alone when the disease recurred within 2 years. The inherent value of ventricular shunting procedures and steroid therapy for recurrent intracranial disease could not be ascertained. The findings in this study suggest that the primary treatment of medulloblastoma should be extended to include chemotherapy and optimum radiation therapy, since once recurrent disease develops retreatment is essentially palliative and a fatal outcome is virtually certain.
Nasal glioma
Authors: Hirsh Leonard F. , Stool Sylvan E. , Langfitt Thomas W. , Schut Luis
Published: May 2009

✓ Six cases of nasal gliomas, which are rare ectopic rests of neural tissue found at the root of the nose, are presented. It is important to distinguish nasal tumors from basofrontal encephaloceles to avoid inadvertent exposure of the brain during the surgical removal of mass lesions. Because of their related embryologic origins, the distinction between nasal gliomas and basofrontal encephaloceles may not be clear clinically. Nasal gliomas may be treated by several surgical specialties, and only a proper awareness of their relationship to encephaloceles can assure the selection of a flexible and adequate surgical approach. This paper emphasizes the salient clinical characteristics of nasal gliomas, their clinical distinction from and embryologic relationship to encephaloceles, and the options for treatment.
Trigeminal artery and microemboli to the brain stem
Authors: Waller Frederick T. , Simons Robert L. , Kerber Charles , Kiesel Ilmar O. , Tanabe Calvin T.
Published: May 2009

✓ The authors report two cases of transient ischemic attacks (TIA's) involving the brain stem. The TIA's were due to microemboli that originated from a carotid bifurcation atherosclerotic plaque and travelled through a persistent trigeminal artery.
Transient amaurosis under decreased atmospheric pressure with sphenoidal sinus dysplasia
Authors: Sugita Kenichiro , Hirota Toshiyuki , Iguchi Ikuzo , Kageyama Naoki , Ito Akikazu
Published: May 2009

✓ The authors report a unique case of transient amaurosis occurring every time the patient flew in a jet plane and frequently when he drove up a mountain. X-ray examination showed dysplasia of the sphenoidal sinus and optic canals. The pathogenesis and the treatment of the amaurosis is discussed.
Abducens nerve paralysis due to giant aneurysm in the medial carotid canal
Authors: Sarwar Mohammad
Published: May 2009

✓ A case of a giant aneurysm located in the medial part of the carotid canal is reported. The patient had isolated abducens nerve paralysis that completely resolved after common carotid ligation in the neck.
The SOSSUS report and its impact on neurosurgery
Authors: Zuidema George D.
Published: May 2009

✓ The recently completed report of the Study on Surgical Services for the United States (SOSSUS) reveals several features of interest to neurosurgeons. There are approximately 2000 individuals practicing neurosurgery in the United States at the present time. Three-fourths of them are board-certified, and about 100 residents complete their training each year. Neurosurgical training rates have been increasing at six to 10 times the growth rate for the nation's population. Despite moderate variation in regional geographic distribution of practicing neurosurgeons, there is no real evidence of underserved areas. Distribution is even in communities with a population of 75,000 and greater. A critical feature of practice is that of work loads. Diagnostic studies make up a large portion of neurosurgical work, and the SOSSUS Area Studies reveal that complex operations are relatively infrequent. This has serious implications regarding the maintenance of clinical competence, and in concentrating sufficient clinical experience to train future generations of neurosurgeons. It is important to realize that the number of neurosurgeons now in practice is sufficient to meet the nation's needs. Selective cutbacks in training programs by approximately 20% seem to be in order, in coordination with similar cuts in the other surgical specialties as well. This should be accompanied by a readjustment to a modest growth rate, approximately 1% per 5 years, in the ratio of neurosurgeons per 100,000 population. An accurate system of data collection is needed to provide the basis for future change in response to alterations in national needs.
Brain-tumor therapy
Authors: Rosenblum Mark L. , Knebel Kathy D. , Vasquez Dolores A. , Wilson Charles B.
Published: May 2009

✓ A recently developed colony-formation assay has been used to evaluate in vivo 1,3-bis (2-chloroethyl)-1-nitrosourea (BCNU) therapy of a transplantable rat brain-tumor model. A comparison of the in vitro colony-forming capacity of treated and untreated tumor cells permits calculation of the fraction of clonogenic tumor cells surviving in vivo therapy. The plateau that we previously observed on the BCNU dose-response curve is not the result of repair of potentially lethal damage, since no change in the 0.1% of surviving clonogenic tumor cells occurs during the first 2 to 4 days after treatment. Although reanalysis of the dose-response curve indicates that sublethal damage exists, its repair is probably minimal. The most likely explanation for the observed limitation of the BCNU effect is the drug's failure to reach all clonogenic cells. A dose of BCNU that kills more than 99.9% of clonogenic tumor cells within 30 minutes of treatment results in only a 60% decrease in tumor weight by Day 14. This disparity is explained by retarded removal of dead cells, and, along with a previously determined 90% cell-kill threshold necessary to appreciate increased animal survival, demonstrates the inherent limitations of measurements of tumor size (including brain scans and clinical patient evaluations) in evaluating the efficacy of brain-tumor therapy. Following an LD10 dose of BCNU the surviving clonogenic tumor cells increase in number after a latency period of 2 to 4 days; during regrowth the cell doubling time is 40 hours. Marked variability in tumor response and regrowth was noted. The determination of information regarding disturbed tumor cell kinetics and tumor heterogeneity is essential for the proper planning of combination chemotherapy and multimodality regimens.
Intraneoplastic injection of methotrexate for experimental brain-tumor chemotherapy
Authors: Tator Charles H. , Wassenaar Willem
Published: May 2009

✓ The retention and distribution of tritiated methotrexate (MTX-3H) after direct intracerebral or intraneoplastic injection were studied in mice bearing subcutaneous or intracerebral ependymoblastomas. After intracerebral injection of MTX-3H in nontumor-bearing animals, a large amount of the drug was retained in the head, much more than could have been retained after systemic administration, and there was rapid spreading of the drug through the ipsilateral hemisphere. Intraneoplastic injection of subcutaneous and intracerebral tumors produced rapid spreading of the drug through the tumors. Initially, the drug was mainly in the interstitial fluid of the tumors followed by earlier cellular uptake than was seen after intravenous injection. Even though the distribution of the drug in the intracerebral tumors was not uniform, and some intracranial tumor deposits contained less radioactivity than areas closer to the site of injection, intraneoplastic injection may have advantages for brain-tumor chemotherapy. However, further experimental study is necessary before clinical application can be recommended, especially evaluation of neurotoxicity after intracerebral, intraneoplastic injection of MTX or other chemotherapeutic agents.
Visualization of a bullet track on brain imaging
Authors: Sain Anil K. , Sham Rajasekar , Silver Lawrence
Published: May 2009

✓ A case is reported in which an intracerebral bullet track was demonstrated by brain imaging. The possible advantages of technetium-99m localization and the role of brain imaging in gunshot injuries of the head are discussed.
Regional cerebral blood flow alterations remote from the site of intracranial tumors
Authors: Endo Hideo , Larsen Bo , Lassen Niels A.
Published: May 2009

✓ Regional cerebral blood flow (rCBF) was investigated in 12 patients with brain tumors, using a 254-channel dynamic gamma camera. In nine of the 12 cases, hyperemic regions with loss of autoregulation were seen in sites remote from the tumor (the area around the tumor was in most cases also hyperemic). These remote rCBF abnormalities were found in the lower posterior part of the hemisphere in six cases, and in the frontal region in three. The location of the remote rCBF abnormality seemed to depend on the site of the tumor: cases with frontal and posterior fossa mass lesions had hyperemia in the lower part of the temporooccipital regions, cases with centroparietal mass lesions had hyperemia mostly in the frontal region. This may mean that the remote rCBF abnormality is due to local tissue compression against unyielding anatomical structures, namely, the tentorium and the falx. It is suggested that these abnormalities may constitute evidence of an early stage of a dangerous clinical condition: a state of preherniation.
Cerebral edema, mass effects, and regional blood volume in man
Authors: Penn Richard D. , Kurtz Diane
Published: May 2009

✓ The authors conducted quantitative analysis of computerized tomography (CT) scans to measure tumor size, cerebral edema, and regional blood volume in man. Mass lesions without edema caused a local reduction in blood volume. Cerebral edema also reduced blood volume in proportion to its severity. Consideration of the electrolyte changes and water shifts in white-matter edema suggested that the decrease in absorption coefficient seen in CT scans was due to the increase in water content. Thus, in cerebral edema separation of blood vessels as well as increased interstitial pressure decrease blood volume, and the regional differences in turn reflect pressure gradients within the brain.
Ruptured intracranial aneurysms
Authors: Post Kalmon D. , Flamm Eugene S. , Goodgold Albert , Ransohoff Joseph
Published: May 2009

✓ The authors review 100 consecutive cases of ruptured intracranial aneurysms to assess the overall morbidity and mortality. Patients were placed on a regimen of bed rest, sedation, control of blood pressure, anticonvulsants, and antifibrinolytic therapy. Surgery was performed on 86 patients with hypotensive anesthesia and microsurgical techniques. The incidence of early rebleeding while on epsilon aminocaproic acid and control of blood pressure was 11.8%. The overall surgical mortality was 8.1%, and the surgical mortality of patients in Grades 1, 2, and 3 was 6.3%. Of the 100 patients, 60 were able to return to their prior activities, and 25 had moderate neurological deficits that required limitation of their activities. The total case mortality was 15%. The evidence presented indicates that the regimen of active medical treatment before microsurgical intervention has improved the overall case morbidity and mortality, as well as the chance for long-term survival.
Cerebrovascular sensitivity to vasoconstricting agents induced by subarachnoid hemorrhage and vasospasm in dogs
Authors: Toda Noboru , Ozaki Takashi , Ohta Tomio
Published: May 2009

✓ In anesthetized dogs, subarachnoid hemorrhage (SAH) was induced by the mechanical rupture of the unilateral intracranial internal carotid artery. Vasospasm was angiographically determined 24 hours and 7 days after SAH. Contractile responses to serotonin, norepinephrine, histamine, and K+ were compared in control and bleeding sides of the middle cerebral arteries removed from dogs with SAH, and from sham-operated dogs. Under sham operation and 2 hours after SAH, responses in the arteries of both sides did not appreciably differ but response was significantly less in arteries from the bleeding side as compared with the control side 24 hours and 7 days after hemorrhage. However, median effective concentrations of serotonin, histamine, and K+ were approximately the same in the arteries from both sides. Vasospasm and decreased sensitivity to the vasoactive agents of middle cerebral arteries were reversed 42 days after SAH. It is thus quite likely that initiation and maintenance of post-hemorrhage vasospasm is not associated with an increase in the sensitivity of cerebral arteries to vasoconstricting endogenous substances, rather the state of decreased sensitivity of cerebral arteries in contact with SAH may be instrumental in relieving prolonged vasospasm.
Use of crocetin in experimental spinal cord injury
Authors: Gainer James V.
Published: May 2009

✓ Mongrel dogs with experimental spinal cord injury were treated with the carotenoid compound crocetin. It has been shown that crocetin increases the diffusion speed of oxygen through plasma, and should provide a net increase in oxygen at the level of the capillary endothelial cell. The treated animals showed a significant improvement in recovery rates as compared to controls.
Neurosurgical endoscopy using the side-viewing telescope
Authors: Apuzzo Michael L. J. , Heifetz Milton D. , Weiss Martin H. , Kurze Theodore
Published: May 2009

✓ The authors report their application of the Hopkins telescope to various neurosurgical procedures, and describe the technique and advantages of its employment.
Familial intracranial aneurysms and cerebral vascular anomalies
Authors: Hashimoto Isao
Published: May 2009

✓ The author reports a family in which four members had intracranial aneurysms and one additional member was suspect. One member had multiple aneurysms that were successfully treated surgically. Elective angiography on five asymptomatic members of the family disclosed asymptomatic aneurysms in two. In addition, cerebrovascular anomalies were found in many of the family members. The parents of the family were consanguineous. High incidence of these associated anomalies and consanguinity in the parents tend to suggest the hereditary basis of the disease. Banding analysis of chromosomes in three siblings with aneurysms and three siblings without aneurysms was carried out. Elective investigation of the asymptomatic members should be considered where there are already two or more affected in a family. The indications for surgical prophylaxis on asymptomatic aneurysms in other members of the family are discussed.
Treatment of mycotic intracranial aneurysms
Authors: Bingham William F.
Published: May 2009

✓ Two patients with mycotic intracranial aneurysms were successfully treated with only antibiotic therapy. One patient, who had subacute bacterial endocarditis, rheumatic valvular disease, and an abscessed tooth, sustained a subarachnoid hemorrhage from a ruptured right middle cerebral artery trifurcation aneurysm. The other patient, who had Turner's syndrome and probable congenital aortic stenosis, developed multiple neurological findings during an episode of acute bacterial endocarditis precipitated by an infected ingrown toenail; a false aneurysm of the distal left middle cerebral artery and two lesions involving the left superior cerebellar artery were found. A study of the literature shows that only 45 patients with mycotic intracranial aneurysms have received adequate antibiotic therapy and angiographic documentation. Statistically, there does not appear to be a clear-cut advantage to antibiotics plus surgical therapy over antibiotics alone. In fact, in 21 patients who underwent serial angiography, lesions were smaller in six and not visualized in 11. In four patients the aneurysms increased in size; in two others fresh lesions formed.

The author proposes the following diagnostic and therapeutic regimen: 1) earliest possible diagnosis of the underlying disorder; 2) appropriate antibiotic therapy; 3) early four-vessel cerebral angiography and follow-up studies every 2 to 3 weeks; 4) definitive surgery without delay if the aneurysm is larger on the first repeat study; 5) definitive operation upon completion of antibiotic therapy if the lesion is larger or the same size; and 6) postoperative angiography to evaluate the effectiveness of treatment and to search for interim lesions.
Aneurysmal tumors of the basifrontal region
Authors: Maxwell Robert E. , Chou Shelley N.
Published: May 2009

✓ The authors report the cases of three men who presented for evaluation of a rapidly progressing dementia. All were found to have a giant aneurysmal mass in the basifrontal region, and all were successfully treated by surgical excision of the mass. The presenting syndrome included rapidly progressive and severe loss of recent memory associated with confusion, chronic headache, wide-based staggering gait disturbance, urinary urgency, frequency, and incontinence, and a fine tremor of the hands exacerbated by purposeful movements. The clinical presentation, radiological assessment, and surgical treatment are discussed.
Effects of subarachnoid hemorrhage on cerebral blood volume, blood flow, and oxygen utilization in humans
Authors: Grubb Robert L. , Raichle Marcus E. , Eichling John O. , Gado Mokhtar H.
Published: May 2009

✓ Forty-five studies of regional cerebral blood volume (rCBV), regional cerebral blood flow (rCBF), and regional cerebral oxygen utilization (rCMRO2) were performed in 30 patients undergoing diagnostic cerebral angiography for evaluation of a subarachnoid hemorrhage due to a ruptured intracranial aneurysm. Tracer methods employing radioactive oxygen-15 were used to measure rCBV, rCBF, and rCMRO2. The patient studies were divided into groups based on their neurological status and the presence or absence of cerebral vasospasm. Subarachnoid hemorrhage, with and without vasospasm, produced significant decreases in CBF and CMRO2. In general, patients with more severe neurological deficits, and patients with more severe degrees of vasospasm, had a more marked depression of CBF and CMRO2. The most striking finding was a significant (p < 0.001) increase in CBV (to 58% above normal) in patients with severe neurological deficits associated with severe cerebral vasospasm. This large increase suggests that cerebral vasospasm consists of constriction of the large, radiographically visible extraparenchymal vessels accompanied by a massive dilation of intraparenchymal vessels.
Intracranial and extracranial neurogenic hamartoma
Authors: Gallo Anthony E. , Smith James D.
Published: May 2009

✓ A case of neurogenic hamartoma involving the middle cranial fossa, nasopharynx, and left anterior cervical region and presenting at birth as an obstructive oropharyngeal mass is described. Special management included Gelfoam embolization of the vascular supply, control of airway and feeding, assessment of biological activity of the mass, and appropriate staging of the procedure with neurosurgical, head and neck surgical, and radiological support.
Aspergillus infection complicating transsphenoidal yttrium-90 pituitary implant
Authors: Feely Michael , Steinberg Marta
Published: May 2009

✓ Diagnosis proved difficult in two cases of Aspergillus infection complicating yttrium-90 ablation of the pituitary. This serious complication occurs rarely. Whatever the initial organism obtained from cases with meningitis of late onset, Aspergillus infection should be considered and cerebrospinal fluid should be cultured for fungi.
Lipoma of the cerebellopontine angle
Authors: Fukui Masashi , Tanaka Akira , Kitamura Katsutoshi , Okudera Toshio
Published: May 2009

✓ The authors present a surgical case of a lipoma of the cerebellopontine angle in a 28-year-old woman.
Microsurgical anatomy of the upper basilar artery and the posterior circle of Willis
Authors: Saeki Naokatsu , Rhoton Albert L.
Published: May 2009

✓ The microvascular anatomy of the posterior part of the circle of Willis, important in surgery of pituitary tumors and basilar aneurysms, was defined in 50 cadaver brains. Significant findings were as follows: 1) Anomalies of the posterior half of the circle of Willis were found in 46% of cases. 2) Hypoplastic P-1 (posterior cerebral segment) and posterior communicating segments gave origin to the same number and size of perforating arteries, having the same termination as normal-sized segments. Thus hypoplastic segments should be handled with care and divided to aid in exposure of the basilar bifurcation only after careful consideration. 3) An average of four perforating branches arose from P-1; most from the superior and posterior surfaces. No branches arose from the anterior surface of the basilar bifurcation. The most proximal P-1 branch originated 2 to 3 mm distal to the basilar bifurcation. It was most commonly a thalamoperforating artery. The largest P-1 branch was usually a thalamoperforating or a posterior choroidal artery. 4) An average of seven branches emerged from the superior and lateral surfaces of the posterior communicating artery. The anterior half was a richer source of perforators than the posterior half. The largest communicating branch in 80% of specimens supplied the premamillary area. 5) The anterior choroidal artery originated from the carotid artery on both sides in all cases. A double anterior choroidal artery was present in 4% of cases.
Early surgical treatment for hypertensive intracerebral hemorrhage
Authors: Kaneko Mitsuo , Koba Tomomi , Yokoyama Tetsuo
Published: May 2009

✓ The authors review 38 cases of hypertensive intracerebral hemorrhage operated on within 7 hours after the apoplectic attack. Microsurgical technique was used for hemostasis and evacuation of the hematoma. At the 6-month follow-up study, 34 patients could walk unaided or with a cane, one was confined in bed, and three had died.
Intracranial hypertension in patients with ruptured intracranial aneurysm
Authors: Hayashi Minoru , Marukawa Shinobu , Fujii Hiroyuki , Kitano Tetsuo , Kobayashi Hidenori , Yamamoto Shinjiro
Published: May 2009

✓ Simultaneous continuous recording of intracranial pressure (ICP) and systemic blood pressure was carried out in 26 patients admitted within 1 week after subarachnoid hemorrhage (SAH) due to a ruptured intracranial aneurysm. The patients were graded as described by Hunt and Hess. Recordings were made for 1 to 5 days. The more impaired the consciousness, the higher the rate of ICP. In Grade III, IV, and V patients, the mean ICP level was in the range of 15 to 40 mm Hg, 30 to 75 mm Hg, and exceeded 75 mm Hg, respectively. A definite correlation between vasospasm shown by cerebral arteriogram and the clinical grade was not observed. In our series of ICP recordings, we never observed a typical plateau wave. The variations of ICP seen in Grade III and IV patients were the B- and C-waves (15 to 45 mm Hg in amplitude) described by Lundberg, and those in Grade V patients were the high amplitude monotonous waves synchronous with the arterial pulses (15 to 40 mm Hg in amplitude). These phenomena may indicate that Grade III and IV patients with SAH are in a condition of cerebral vasomotor instability, and Grade V patients have cerebral vasomotor paralysis.
On the origin and nature of the pituitary gland capsule
Authors: Ciric Ivan
Published: May 2009

✓ Observations under the operating microscope confirming the presence of a pituitary capsule are reported. This capsule envelops the anterior lobe of the pituitary, the neurohypophysis, and the pituitary stalk. It merges along the stalk with the intracranial pia mater. The origin and nature of this capsule are discussed in light of the known facts of development of the pituitary gland and surrounding structures. It is concluded that the pituitary gland capsule is a derivative of the primitive pia mater.
Pituitary abscesses
Authors: Domingue James N. , Wilson Charles B.
Published: May 2009

✓ Seven cases of pituitary abscess are presented and the relevant world literature is reviewed. An enlarged sella co-existing with bacterial meningitis, or bacterial meningitis coinciding with a known or suspected pituitary tumor should suggest the diagnosis of pituitary abscess. Visual field defects should evoke similar suspicion when present in a patient with meningitis. This reasoning enabled us to make the first reported preoperative diagnosis of pituitary abscess. Therefore, in the management of purulent meningitis, we recommend the following: first, skull films are mandatory; second, if the sella turcica is abnormal, the correct presumptive diagnosis is pituitary abscess; and third, if prompt improvement does not follow appropriate antibiotic therapy, the suspected abscess should be explored and drained via the transsphenoidal approach.
Posterior partial rootlet section in the treatment of spasticity
Authors: Fraioli Bernardo , Guidetti Beniamino
Published: May 2009

✓ Twenty-six patients were operated on using a technical modification of Förster's method of treating spasticity, which consists of a partial section of the rootlets constituting the posterior roots. Many patients had mild cerebral spastic quadriplegia or spastic diplegia: several of them were nearly independent when standing or walking, and two of them completely independent. The spastic disorders that were not made worse by voluntary movements were reduced or abolished in all but one patient, in whom rootlet section was insufficient. The spastic disorders that were made worse by voluntary movements were only partially reduced; after operation they were scarcely evident or absent in a static position, but evident during voluntary movements. No improvement was observed in one patient who suffered from spastic disorders that were evident only during voluntary movements, or in one patient suffering from dystonia. The procedure caused no sensory disorders. The operation was especially useful in patients who were acquiring or had already acquired independence when standing or walking.
Release of antidiuretic hormone during mass-induced elevation of intracranial pressure
Authors: Gaufin Lynn , Skowsky W. Ronald , Goodman Stanley J.
Published: May 2009

✓ There are complex osmotic and non-osmotic factors regulating release of antidiuretic hormone (ADH). A wide variety of intracranial pathological processes may trigger ADH release sufficient to produce clinically recognizable hyponatremia, or the “inappropriate ADH syndrome.” We systematically studied one non-osmotic trigger, namely mass-induced elevated intracranial pressure (ICP). Initial experiments established baseline data in normal rhesus monkeys: anesthetized animals displayed appropriate rises and falls in immunoreactive urinary ADH in response to intravenously administered hypertonic and hypotonic infusions. Next, balloon catheters were implanted subdurally over temporal lobes and the animals were allowed to recover. The final experiment consisted of anesthetizing the animals, monitoring arterial blood pressure and blood gases, and retrieving timed urinary specimens while continuously recording ICP during infusion-pump expansion of the subdural balloon. A nonlethal and a lethal series of balloon-expansion experiments were done. Control values of urinary ADH were 783 ± 125 µU/15 min, and ICP was less than 10 mm Hg. During nonlethal mass expansion ADH output rose to 3433 ± 269 µU/15 min while ICP averaged 65 mm Hg (measured at completion of mass expansion). While the mass was maintained, hypotonic infusion produced unchanged urinary ADH output of 3452 ± 277 µU/15 min. During lethal experiments, urinary ADH rose still higher to 4339 ± 1887 µU/15 min associated with ICP averaging 100 mm Hg. We concluded that there is a direct relationship between the magnitude of ICP and the amount of ADH release, and that during elevated ICP the ADH release is not suppressed by hypotonic infusion.
Orbital cortical influences on cardiovascular dynamics and myocardial structure in conscious monkeys
Authors: Hall Richard E. , Livingston Robert B. , Bloor Colin M.
Published: May 2009

✓ The posterior orbital cortex of the frontal lobes in conscious monkeys was stimulated electrically to study the influence of this structure on cardiovascular hemodynamics and cardiac morphology. Stimulating electrodes, cardiac output flow probes, and arterial blood pressure transducers were chronically implanted by aseptic procedures into eight Macaca fascicularis monkeys. Cardiovascular changes induced by stimulating the orbital cortex included both biphasic and unidirectional alterations in cardiac output, blood pressure, heart rate, stroke volume, and total systemic resistance. Electrode position and the rate (Hz) of applied stimulation were the primary determinants of the direction and magnitude of the response. All animals stimulated demonstrated acute, discrete interventricular septal myocytolysis, characteristic of early ischemic lesions. Since the orbital cortex is a part of the limbic system, changes induced by its stimulation suggest a pathophysiological mechanism whereby emotional expression may effect dynamic shifts in cardiovascular functions and may thus induce permanent and manifest myocardial lesions.
Hemorrhage from a previously undemonstrated intracranial aneurysm as a late complication of carotid artery ligation
Authors: Klemme William M.
Published: May 2009

✓ A case is reported in which the patient underwent ligation of the common carotid artery as treatment for a ruptured intracranial aneurysm. Nine years later a second subarachnoid hemorrhage occurred from a new or previously undemonstrated intracranial aneurysm. Recannulation of the ligated carotid artery was demonstrated by arteriography. Similar cases are cited from the literature.
Traumatic atlantooccipital dislocation
Authors: Fruin Alan H. , Pirotte Thomas P.
Published: May 2009

✓ A case of traumatic atlantooccipital dislocation is presented and the literature reviewed. This type of traumatic dislocation is probably produced by violent hyperextension of the upper cervical spine. Cranial nerve injuries and spinal cord injuries are common. Early fusion is recommended.
“Bicycle test” of van Gelderen in diagnosis of intermittent cauda equina compression syndrome
Authors: Dyck Peter , Doyle John B.
Published: May 2009

✓ The authors describe a simple clinical adjunct to the routine neurological examination of patients with intermittent cauda equina compression syndrome. The “bicycle test” helps exclude intermittent claudication due to vascular insufficiency and frequently confirms the relationship of posture to radicular pain.
Skull tumor simulating sinus pericranii
Authors: Manaka Shinya , Izawa Masahiro , Nawata Hiroshi
Published: May 2009

✓ A case of skull tumor simulating sinus pericranii is presented. The tumor was situated in the occiput near the midline and it was thought to satisfy the diagnostic criteria of sinus pericranii. At operation the tumor proved to be eosinophilic granuloma with intratumorous hemorrhage associated with epidural hematoma.
Abnormal movements with hydrocephalus
Authors: Banerjee Timir
Published: May 2009

✓ The author reports the case of a pituitary dwarf with choreoathetoid movement of the tongue and both arms as results of a shunt malfunction. He had undergone craniotomy for excision of a suprasellar craniopharyngioma, and 13 years later complete cerebral angiography and Conray ventriculography showed massive hydrocephalus with no evidence of tumor recurrence. Revision of the shunt was followed by complete recovery of the movement disorder.
Agenesis of the left internal carotid artery associated with an aneurysm on the right carotid syphon
Authors: Servo Antti
Published: May 2009

✓ A case is reported with congenital absence of the left internal carotid artery associated with an aneurysm on the contralateral carotid syphon. Eight similar cases are reviewed in brief. The possibility of hemodynamic abnormality as the cause of the aneurysm is discussed.
Traumatic arteriovenous fistula of the vertebral artery with spinal cord symptoms
Authors: Nagashima Chikao , Iwasaki Takashi , Kawanuma Seiichi , Sakaguchi Arata , Kamisasa Akira , Suzuki Kenichi
Published: May 2009

✓ The authors report a case of a traumatic vertebral arteriovenous fistula with spinal cord symptoms. Direct closure of the fistula was followed by rapid improvement.
Interstitial gamma irradiation by 198Au of the pituitary in diabetic retinopathy
Authors: Schaub Claude , Szikla Gabor , Drouin Pierre , Bluet-Pajot Marie-Thérèse , Mejean Luc , Debry Gerard , Talairach Jean
Published: May 2009

✓ Pituitary interstitial irradiation by stereotaxic implantation of a gamma pointemitter was performed in 110 patients with progressing diabetic retinopathy. Reduction of growth hormone secretion peaks was delayed, but was consistent and selective in all cases controlled by somatotropin stimulation tests, while other pituitary secretions remained unchanged in all but five cases. In 31 patients who had no associated photocoagulation, long-term postoperative assessment showed significant improvement of hemorrhages and intraretinal new vessels with preservation of visual acuity. Preretinal vascular proliferation (except when treatable by photocoagulation), extensive retinitis proliferans, and macular deterioration are contraindications. This technique represents a new approach in the functional pituitary neurosurgical treatment of diabetic retinopathy and differs from all other procedures that result in a more or less complete hypophysectomy.
The mechanism of spinal cord cavitation following spinal cord transection
Authors: Kao Chun C. , Chang Louis W. , Bloodworth James M. B.
Published: May 2009

✓ The authors report their findings by electron microscopy after microsurgical subpial spinal cord transection in dogs. After cord transection, conspicuous myelin microcysts are formed in a background of otherwise intact cord tissue at a distance of 1 to 2 mm from the cut end of the cord, both proximal and distal to the transection. Seen through the electron microscope, the microcyst is a myelin sac distended by fluid under pressure, containing a swollen axon filled with excessive axoplasmic organelles; that is, a terminal club. Later the microcysts and terminal clubs rupture. The large spaces within the microcysts are opened to heretofore small extracellular spaces and the spinal cord tissues are destroyed. Thus, microcysts are precursors of large cavities seen at the ends of transected cord stumps. The formation of microcysts and their subsequent rupture, which leads to cord cavitation, is interpreted as an inherent response of cord tissue to injury, and the result of an abortive attempt at cord regeneration.
The mechanism of spinal cord cavitation following spinal cord transection
Authors: Kao Chun C. , Chang Louis W. , Bloodworth James M. B.
Published: May 2009

✓ Cavitation adjacent to transection of spinal cords can be successfully eliminated by a second operation 1 week after the initial spinal cord transection. The second operation consists of removal of the necrotic spinal cord tissue, thus producing a gap. Segments of autogenous sciatic nerve are inserted into the gap between the spinal cord stumps. If the spinal cord is injured by retransection at the second operation, cavitation again occurs in the spinal cord stumps resulting in separation of the nerve grafts from the spinal cord. The results of the present experiments support the concept that lysosomal spinal cord autotomy, which causes spinal cord cavitation, is a self-limiting process and that once the spinal cord has completed the autotomy, the process will not occur again unless the spinal cord is again traumatized.
Mechanical and physiological effects of dentatotomy
Authors: Cusick Joseph F. , Ackmann James J. , Larson Sanford J.
Published: May 2009

✓ The role of the dentate ligaments in the pathogenesis of myelopathy secondary to disease conditions that alter the normal biomechanics of the spinal canal was studied in 14 dogs. The effects of posterior cord elevation on somatosensory evoked potentials (SSEP's) and tension requirements were compared before and after dentate ligament section in acute experiments. At levels of posterior elevation usually within the confines of the canine canal, the dentate ligaments were the most significant element increasing tension requirements and SSEP alterations. Human cadaver studies also showed an approximate 50% reduction of force after dentatotomy. These findings suggest that after dentate ligament section the applied tension is distributed over a longer segment of the cord with a reduction in tension and disruption of axonal conduction at the level at which the force was applied.
Physiological consequences of experimental cerebral missile injury and use of data analysis to predict survival
Authors: Crockard H. Alan , Brown Frederick D. , Calica Arnold B. , Johns Lydia M. , Mullan Sean
Published: May 2009

✓ The authors describe cerebrovascular and cerebral metabolic changes in monkeys subjected to cerebral missile injury. After injury with a BB pellet at 90 m/sec, there is a rapid rise in intracranial pressure (ICP), which reaches a peak 2 to 5 minutes posttrauma, and then falls to about 20 to 30 mm Hg. This, with a fall in mean blood pressure (MBP), results in a 50% reduction in cerebral perfusion pressure (CPP). Cerebral blood flow (CBF) is also reduced, although acutely there is no close relationship with CPP. Cerebrovascular resistance falls initially and then at 30 minutes rises to very high values. Cerebral metabolic rates (CMR's) for oxygen fall after injury and remain low for the rest of the animal's life; CMR's for lactate rise immediately after injury and persist for 5 hours, then fall. After injury with a faster missile (180 m/sec), the ICP rises higher and faster, and the peak is shorter. The CPP is reduced in this injury to approximately 30 mm Hg, and only one animal survived more than 1 hour.

With the conventional forms of data analysis, the length of survival after injury correlates well with MBP, ICP, and CBF, but separately they were completely unsatisfactory for prediction of an individual's prognosis. With the technique of multiple linear regression analysis, the survival of individual animals could be predicted with great accuracy. This is possible also when two postinjury parameters, CBF and MBP, are used.
Intracranial aneurysm in infancy
Authors: Morelli Robert J. , Laubscher Frederick
Published: May 2009

✓ Angiography demonstrated an aneurysm of the left anterior cerebral artery in a 4-month-old baby who was admitted for subarachnoid hemorrhage. A surgical cure with long-term follow-up course was achieved. Clinical and pathogenetic aspects are presented. The rarity of such lesions in childhood and their successful surgical treatment are discussed briefly.
Extracranial holder for brain retractors
Authors: Kanshepolsky José
Published: May 2009

✓ A new extracranial holder for brain retractors is described. It is suitable for solid incorporation onto the sliding rails of the operating table, and has been satisfactorily employed in the operating room for over a year.
Anterior commissurotomy for intractable pain
Authors: King Robert B.
Published: May 2009

✓ Anterior commissurotomy for the relief of intractable lower half and midline pain has been found to be a very satisfactory procedure in a small group of severely incapacitated patients. The presumed anatomic rationale for undertaking the procedure has not been confirmed by postoperative sensory examinations. Alternative explanations for its effectiveness remain conjectural. The operative procedure is described.