bluuebunny/crossref_metadata_2025 huggingface dataset:
Cerebrospinal Fluid Dynamics in Patients with Pseudotumor Cerebri
Authors: Sklar Frederick H. , Beyer Chester W. , Ramanathan Murugappan , Cooper Paul R. , Clark Kemp W.
Published: May 2010

CSF dynamics were determined as a function of intracranial pressure in patients with pseudotumor cerebri. Servocontrolled variable rate lumbar infusions were used to determine net CSF-absorptive capacities and resting pressures in 10 patients; serial studies were done in 5 of the patients. Nearly all of the patients had abnormally low CSF-absorptive capacities. On the other hand, marked elevations in resting pressure were not a constant feature of the disease. Concurrent changes in the cerebrovascular bed could introduce errors into this manometric determination of CSF dynamics; the significance of this potential artifact is examined. The results of this study suggest that the CSF compartment may be of etiological importance in the pathophysiology of pseudotumor cerebri.
Cerebellar Stimulation in the Management of Cerebral Palsy
Authors: Wong Peter K. H. , Hoffman Harold J. , Froese Alison B. , Platt Jay L. , Blach S. , Gear J.
Published: May 2010

Cerebellar stimulators were inserted into seven children who had cerebral palsy and in whom extensive investigation. including computerized tomography, had revealed no structural brain abnormality. A team including physiotherapists, occupational therapists, speech pathologists, and respiratory physiologists assessed the children pre- and postoperatively; their somatosensory evoked potentials were also measured. The mean age at implantation was 8.6 years; follow-up has ranged from 8 to 23 months (mean, 17.3 months). No adverse effects of the cerebellar stimulation have been noted. Detailed case histories obtained from the parents, together with formal assessment scores, indicate good improvement in six patients and mild but significant improvement in the seventh. Clinically, there has been gradual improvement in all seven patients. The charge density range associated with clinical improvement was 0.8 to 2.1 μCi/cm2/phase. The stimulation equipment must be monitored very carefully to ensure that any variation from the desired output is acceptably small because it is probable that sizable deviation is a determining factor in lack of response to this therapy.
Dorsal Spinal Cord Stimulation in the Treatment of Multiple Sclerosis
Authors: Young Ronald F. , Stanley Stanley J.
Published: May 2010

Previously published work indicated significant improvement in the symptoms of multiple sclerosis with dorsal spinal cord stimulation. In this study 23 patients with multiple sclerosis documented by history, examination, laboratory studies, and clinical course were treated with dorsal spinal cord stimulation and followed for 19 to 45 months (mean, 32 months). Preand postoperative clinical assessment was carried out using the Kurtzke Scale. Walking velocity, upper limb coordination, sphincter function, and sensory function were also evaluated quantitatively. No statistically significant objective improvement in any of these measures was demonstrated. Fifty per cent of the patients initially reported subjective symptomatic improvement, but this declined to 30% at last follow-up. Fifteen of 23 patients experienced complications related mainly to the hardware used and required a total of 21 subsequent operative procedures for correction of these complications. These results do not support the continued clinical use of dorsal spinal cord stimulation in the symptomatic treatment of multiple sclerosis.
The Trapped Temporal Horn
Authors: Smith Harold , Moody Dixon , Ball Marshall , Laster Wayne , Kelly David L. , Alexander Eben
Published: May 2010

Although the advent of computerized cranial tomography (CT) has decreased the number of pneumoencephalograms performed for the diagnosis of hydrocephalus and lesions of the posterior fossa, brain stem, and ventricles, there are some patients in whom pneumoencephalography should still be done because it adds valuable information to that obtained with CT. When the temporal horn becomes obstructed, the choroid plexus and ependymal surface “upstream” from the obstructing mass continue to produce cerebrospinal fluid (CSF). The temporal horn can thus enlarge enough to appear as a mass on CT because of its reduced x-ray attenuation coefficient. Pneumoencephalography is effective in this situation because air will flow past a mass that obstructs CSF and because the ventricular system dilates during pneumoencephalography. When pneumoencephalography is used in a patient with a trapped temporal horn, the partially trapped horn may enlarge approximately 24 hours later. With that precaution in mind, the neurosurgeon should find pneumoencephalography to be a useful adjunct to CT in delineating the cause of a trapped temporal horn. In the three patients reported here CT had indicated a unilateral trapped temporal horn; pneumoencephalography confirmed that finding and demonstrated both the location and the nature of the lesion. One patient had a Grade II astrocytoma fungating into the atrium of the right lateral ventricle, one had a mass extending into the right ventricle from the medial and superior ventricular wall with nodular encroachment on the ventricle, and one had a meningioma in the atrium of the right lateral ventricle.
Rupture of Intracranial Aneurysms during Cerebral Angiography
Authors: Koenig George H. , Marshall William H. , Poole Joseph G. , Kramer Richard A.
Published: May 2010

Ten new cases of intracranial aneurysms that ruptured during cerebral angiography, obtained from four local hospitals and the practices of eight angiographers, are detailed. A review of the literature reveals 28 other well-documented cases. An analysis of this clinical material shows that internal carotid injections are not necessarily more dangerous than common carotid injections. Although critically ill patients are at higher risk and must be treated with caution, there is not enough evidence to warrant a delay in angiography to avoid rupture. The recent trend toward early angiography in cases of subarachnoid hemorrhage is reflected in the statistical analysis. A plea for meticulous angiographic technique is advanced.
Selective Treatment of Infants with Myelomeningocele
Authors: Black Peter McL.
Published: May 2010

Selective treatment of infants with myelomeningocele is said to be beneficial to the infants, their parents, and to society. One group of arguments intended to support this point of view is analyzed. Recent data do not support the factual basis on which these arguments rest; moreover, the moral assumptions that lie behind them should be emphasized. The values held by participants in a discussion of allowing infants to die are as important as facts about treatment options.
Spinal Epidural Neurostimulation for Treatment of Acute and Chronic Intractable Pain
Authors: Richardson Robert R. , Siqueira Edir B. , Cerullo Leonard J.
Published: May 2010

Spinal epidural neurostimulation, which evolved from dorsal column stimulation, has been found to be effective in the treatment of acute and chronic intractable pain. Urban and Nashold have shown that it is a safe, simplified alternative to dorsal column stimulation, especially because laminectomy is not required if the electrodes are inserted percutaneously. Percutaneous epidural neurostimulation is also advantageous because there can be a diagnostic trial period before permanent internalization and implantation. This diagnostic and therapeutic modality has been used in 36 patients during the past 3 years at Northwestern Memorial Hospital. Eleven of these patients had acute intractable pain, which was defined as pain of less than 1 year in duration. Initial postimplantation results from the 36 patients indicate that spinal epidural neurostimulation is most effective in treating the intractable pain of diabetes, arachnoiditis, and post-traumatic and postamputation neuroma. Long term follow-up, varying from 1 year to 3 years postimplantation in the 20 initially responding patients, indicates that the neurostimulation continues to provide significant pain relief (50% or greater) in a majority of the patients who experienced initial significant pain relief.
Closed Irrigation-Suction Technique in the Treatment of Lumbar Laminectomy Infection
Authors: Garrido Eddy
Published: May 2010

The irrigation-suction technique was used to treat a patient who developed a deep infection after removal of a herniated lumbar disc. The patient made an excellent recovery. The advantages of this modality of treatment over the standard approach to this problem are emphasized.
Risk of Intracranial Aneurysm Surgery in the Good Grade Patient
Authors: Samson Duke S. , Hodosh Richard M. , Reid William R. , Beyer Chester W. , Clark William Kemp
Published: May 2010

To evaluate the risk of definitive intracranial microsurgical aneurysm obliteration as a function of the timing of the operative intervention, we retrospectively reviewed 106 consecutive patients in good clinical condition who underwent such surgery. The patients who were operated upon within the first 8 days of their most recent subarachnoid hemorrhage formed the “early” group; the patients operated upon between the 9th and 31st day were considered to have undergone “late” surgery. On the basis of their clinical outcome the patients were allocated to one of four outcome categories (“good,” “fair,” “poor,” “death”) both at the time of their hospital discharge and at their most recent clinical re-evaluation, a minimum of 6 months after discharge from the hospital. There was no significant difference in the operative mortality in each group (early surgery, 5%; late surgery, 4%); additionally, no significant difference was noted in the incidence of either intraoperative complications or postoperative morbidity. A suggestive but statistically insignificant increase in the incidence of postoperative cerebral ischemic events was seen in the “early” surgery group (8% vs. 4% for the “late” surgery group). The potential significance of these findings for the timing of intracranial aneurysm surgery is discussed.
Acquired Middle Cranial Fossa Fistulas
Authors: Kaufman Benjamin , Yonas Howard , White Robert J. , Miller Clinton F.
Published: May 2010

To the accepted classification of three types of normal pressure, nontraumatic cerebrospinal fluid (CSF) fistulas, we would add “acquired.” This type of CSF fistula tends to occur from the middle cranial fossa because of the enlargement of “pitholes” that are normally present in its anterior medial aspect. The enlargement of these bony defects is due to normal intracranial pressure variations that, not uncommonly, create meningoceles and meningoencephaloceles. A portion of the floor of this area is aerated in up to 10% of the normal population by the lateral recess of the sphenoid sinus, the pterygoid recess. Thus, this area has the potential to act as a pathway between the middle fossa and the paranasal sinuses, allowing cerebrospinal fluid to pass into the sinuses. Isotope and computerized tomographic studies are helpful in the localization of such a CSF leak. Tomography of the base of the skull, however, is essential for the ideal definition of possible routes of fistulization. If there is any question of the presence of a middle fossa fistula, these studies can show whether the floor of this area is pneumatized and whether there are any defects in the floor. The treatment of such a fistula should include generalized reinforcement of the floor of the anterior middle fossa by a middle fossa approach. If any doubt exists as to the site of leakage (anterior or middle fossa), the minimal surgical procedure should include exploration of both areas via a frontotemporal craniotomy.
Meningiomas of the Pineal Region and Third Ventricle
Authors: Rozario Rodney , Adelman Lester , Prager Robert J. , Stein Bennett M.
Published: May 2010

The clinical presentation, radiological findings, and surgical management of two cases of meningioma arising from the velum interpositum without dural attachment are described. The true nature of these tumors was not suspected despite extensive preoperative diagnostic evaluation. A total removal was effected in both cases with the use of the operating microscope and a posterior fossa approach to the pineal region. A review of similar cases from the English literature is presented.
Metastasis of a Rectal Carcinoid to the Posterior Fossa
Authors: Bouldin Thomas W. , Killebrew Kate , Boone Stephen C. , Gay Robert M.
Published: May 2010

We report the metastasis of a rectal carcinoid to the dura mater of the posterior fossa. The clinical presentation was unusual because of a 10-year latent period between resection of the primary rectal tumor and symptoms and signs of the posterior fossa metastasis; the radiological findings were atypical of a metastasis. Gastrointestinal carcinoids, apudomas, and the concept of the APUD endocrine cell family are reviewed.
Extradural Hematoma Associated with Traumatic Middle Meningeal Artery Pseudoaneurysm
Authors: Garza-Mercado Román , Rangel Ricardo A.
Published: May 2010

Two new cases of extradural hematoma associated with traumatic middle meningeal artery pseudoaneurysm are presented. Sixteen such cases have previously been reported in the literature. A 22-year-old man and a 17-year-old woman each developed marked neurological deficits after head injury. In each case percutaneous common carotid angiography demonstrated a conspicuous aneurysmatic sac on the middle meningeal artery, as well as displacement of major intracranial vessels and a surrounding avascular area. At operation the extradural clot was removed and the middle meningeal artery sac was verified. Both patients recovered uneventfully. Histological analysis of one of the specimens was performed.
Increased Intraventricular Pressure without Ventriculomegaly in Children with Shunts
Authors: Engel Murray , Carmel Peter W. , Chutorian Abe M.
Published: May 2010

Five patients with shunt-dependent hydrocephalus were observed to have apparently normal ventricular size despite marked increases in ventricular pressure after shunt malfunction. Elastance (dP/dV) was determined in four of these patients by removing increments of cerebrospinal fluid and measuring the resulting pressure. These patients without ventricular enlargement and with markedly increased ventricular pressure had high elastance. This group of patients with “normal volume” hydrocephalus had distal shunt occlusions, in contrast to previously reported patients with cephalic shunt obstructions after ventricular decompression. Initial shunting in early infancy, prolonged shunt dependency, and lack of recent shunt revision were common factors in these patients. Markedly elevated pressure with normal volume is a threatening clinical entity, requiring prompt surgical intervention.
Cushing's Disease with Cyclic Hormonogenesis and Diabetes Insipidus
Authors: Oates Thomas W. , McCourt Jerome P. , Friedman William A. , Agee O. Frank , Rhoton Albert L. , Thomas William C.
Published: May 2010

A cyclic excess of cortisol secretion was detected in a patient with diabetes insipidus and diabetes mellitus. The cycles of hypercortisolism were of 7 days' duration, but during the nadir of these cycles urinary excretion of corticosteroids and 17-ketosteroids was within the normal range. The radiological appearance of the sella turcica was normal; however, computerized axial tomography of the head revealed a small tumor immediately superior to the sella turcica. At operation a small chromophobe adenoma superior to the diaphragma sellae and involving the hypophysial stalk was partially resected. Postoperatively, the patient continued to have 7-day cycles of increased corticosteroid excretion, but the amounts excreted were less than they had been preoperatively. Other patients have been described in whom Cushing's disease has been due to cyclic hypercortisolism. These cycles have been remarkably regular in individual patients, but of variable duration in different patients. Furthermore, cyclic hormonogenesis probably occurs in a variety of endocrinopathies.
Extraparenchymal Sarcoid Mass
Authors: Lax Fredric , Tabaddor Kamran
Published: May 2010

Sarcoidosis frequently involves the nervous system, but intracranial sarcoid mass lesions are rare. A case of a subfrontal extraparenchymal sarcoid mass mimicking a meningioma is presented. Previously reported cases of intracranial sarcoid mass lesions are reviewed.
Spinal Subdural Hematoma
Authors: Guthikonda Murali , Schmidek Henry H. , Wallman Lester J. , Snyder Thomas M.
Published: May 2010

A case of lumbar spinal subdural hematoma in a patient who had been on anticoagulant therapy is reported. Thus far 19 cases of spinal subdural hematoma have been reported in the literature, the majority in patients with a bleeding diathesis and after a lumbar puncture. Our case is the third reported to be in association with anticoagulant therapy. The hematoma was lumbosacral, in contrast to the usual location in the dorsal-lumbar area. A possible mechanism for the production of spinal subdural hematoma after a lumbar puncture is discussed. An early decompressive laminectomy and evacuation of the hematoma is the recommended treatment to obtain the best possible recovery of neurological function.
Delayed Traumatic Intracerebral Hematomas after Surgical Decompression
Authors: Hirsh Leonard F.
Published: May 2010

Delayed traumatic intracerebral hematomas found after an initially unrevealing computerized tomographic scan have been reported occasionally. Such hemorrhage may occur in an area of brain contusion with cerebral vessel injury. Four cases of intracerebral hematoma appearing after evacuation of a different traumatic intracranial mass lesion are reported. This suggests that an intracranial mass lesion may tamponade cerebral venous oozing in an area of brain contusion and delay the accumulation of intracerebral blood, accounting for the late discovery of a parenchymal hematoma.
Cardiac Arrhythmias Associated with Subarachnoid Hemorrhage
Authors: Vidal Bruno Estañol , Dergal Elias Badui , Cesarman Eduardo , San Martin Oscar Marin , Loyo Mauro , Lugo Bartolome Vargas , Ortega Roberto Perez
Published: May 2010

This is a prospective study of cardiac arrhythmias in patients with acute subarachnoid hemorrhage (SAH) secondary to ruptured aneurysm. Twenty per cent of the patients had serious, life-threatening arrhythmias. However, 100% of the patients had some kind of cardiac arrhythmia. The arrhythmias occurred during the first 48 hours after SAH. Such arrhythmias occur in patients without overt, pre-existing heart disease, hypoxemia, or electrolyte imbalance. A prolonged Q-T interval is frequently observed in patients with SAH who develop serious ventricular arrhythmias.
Mechanisms of Hyperventilation in Head Injury
Authors: Leitch A.G. , McLennan J.E. , Balkenhol S. , Loudon R.G. , McLaurin R.L.
Published: May 2010

We report the case of a head-injured patient with spontaneous hyperventilation who had recurrent episodes of relative hypoventilation associated with increases in intracranial pressure. Detailed ventilatory studies were performed during the 2nd week after injury. Our findings in this patient prompted us to review the possible mechanisms underlying the observed changes. We suggest that spontaneous hyperventilation in head injury is secondary to a decrease in cortical inhibitory influences on respiratory control mechanisms and that the transient episodes of relative hypoventilation observed in our patient may reflect modified ventilatory responses dependent on the altered state of consciousness.
Pneumocephalus after Ventriculoatrial Shunt
Authors: Steinberger Abe , Antunes John L. , Michelsen W. Jost
Published: May 2010

Pneumocephalus developing after a ventriculoatrial shunting procedure is described. This was found to be caused by a defect in the posterior wall of the frontal sinus, possibly secondary to chronically increased intracranial pressure. A review of the pertinent literature revealed only two other similar cases.
Invasive Pituitary Adenoma with Abscess Formation
Authors: Zorub David S. , Martinez A. Julio , Nelson Paul B. , Lam Man-Tai
Published: May 2010

A case is presented and 10 cases are reviewed in which abscess formation developed in an intrasellar tumor. The diagnosis was made preoperatively or before autopsy in only 1 patient. The mortality rate was greater than 50%. The most common presentation was headache, fever, and visual disturbances with an abnormal sella and sterile cerebrospinal fluid (CSF). Nonconstant findings included meningeal signs and leukocytosis of the CSF. Trans-sphenoidal removal of the tumor and drainage of the abscess with appropriate antibiotic therapy is recommended.
Value of Sequential Computed Tomography in the Multimodality Treatment of Glioblastoma Multiforme
Authors: Salcman Michael , Levine Harvey , Rao Krishna
Published: May 2010

Previous assessments of the value of sequential computed tomographic (CT) scanning in brain tumor patients have suffered from the heterogeneous nature of the study populations in regard to (a) pathology, (b) treatment plan, and (c) time of scanning. This report is based on the first 21 of 30 consecutive cases of glioblastoma multiforme entered into a cumulative high dose chemotherapy study. Each patient received a maximal surgical resection, 5800 to 6300 rads of radiation therapy, and BCNU (1,3-bis(2-chloroethyl)-1-nitrosourea) chemotherapy (beginning at 100 mg/m2/day × 3 days) every 8 to 10 weeks for the life of the patient. CT scans were obtained pre- and postoperatively and at each admission for chemotherapy; the scan at the time of the first BCNU course served as the postradiotherapy scan. Edema was present on 94% of the initial scans, and 94% of the tumors demonstrated contrast enhancement. In 70 instances it was possible to compare clinical status and an enhanced scan at the time of an adjuvant treatment. When the scan was improved or unchanged so was the patient (46 of 46), but worsening of the scan was accompanied by worsening of the patient only 62% of the time (15 of 24). Sequential CT scanning proved useful in (a) detecting the positive effect of a treatment plan in clinically stable patients; (b) detecting non-tumor related causes of clinical deterioration; (c) detecting early treatment failure as a prelude to reoperation and/or a change in drug protocol before clinical deterioration; and (d) detecting asymptomatic complications of the treatment plan (i.e., a 20% incidence of ventricular enlargement).
Multiple Primary Brain Tumors of Different Cell Types
Authors: Deen Gordon H. , Laws Edward R.
Published: May 2010

Eighteen cases of multiple primary brain tumors of different histological types were found in a review of Mayo Clinic records from 1950 to 1978. The predisposing factors, clinical presentation, location, and type of tumor are discussed. The clinical significance and etiology of these multiple tumors are considered.
Central Nervous System Metastases in Malignant Melanoma
Authors: Bullard D. E. , Cox E. B. , Seigler H. F.
Published: May 2010

In a series of 1341 patients with histologically proven malignant melanoma seen at Duke University Medical Center from 1968 to 1978, 107 patients developed central nervous system (CNS) metastases. These patients were evaluated on the basis of which factors were associated with the development of CNS metastases. Male patients, patients with invasive primary lesions as measured by Clark's system, and patients with primary lesions of the head/neck or oral mucosa had higher incidences of CNS metastasis. Age and race were not significant factors. Clinically, single CNS metastases were seen in 48.8% of the patients; multiple cerebral lesions were seen in 37.2% of the patients. In 22% of the patients there was CNS metastasis alone, in 41% a second organ was involved, and in 20% three organs were involved.
Osteoid Osteomas and Osteoblastomas of the Spine
Authors: Janin Yves , Epstein Joseph , Carras Robert , Khan Arfa
Published: May 2010

Benign osteoblastic lesions are rare bone tumors and they are usually divided into osteoid osteomas and benign osteoblastomas based on their biological behavior. Both lesions are prevalent in the spine, with the lamina and pedicle being involved frequently. Long diagnostic delays are frequent. Pain, the most prominent symptom, is often nocturnal and is relieved by aspirin in 30 to 40% of patients. Radicular pain occurs in 50% of the patients. The most common physical finding is tenderness in the vicinity of the lesion. Neurological abnormalities are more frequent in patients with osteoblastomas, which frequently extend into the neural canal. Tomograms are invaluable in most patients in whom plain films are normal. The bone scan is one of the most important diagnostic studies and provides an excellent means of following patients postoperatively. Myelograms do not always demonstrate the epidural extensions. Computed tomography accurately demonstrates the location and extent of the tumor. Permanent relief of pain and neurological recovery is dependent primarily on total removal of the lesion.
Diverse Clinical Applications of Percutaneous Lumboperitoneal Shunts
Authors: James H. E. , Tibbs P. A.
Published: May 2010

A population of 28 patients underwent the percutaneous placement of a shunt in the lumbar region with a single tube, the other end of which was placed in the peritoneal cavity by laparotomy. The clinical indications for the procedure were: communicating hydrocephalus (16 patients), pseudotumor cerebri (3 patients), cranial cerebrospinal fluid fistula (4 patients), and a bulging postcraniotomy site (2 patients). An additional 3 patients were treated by lumbar subcutaneousperitoneal shunt for a cerebrospinal fluid (CSF)-subcutaneous fistula after the removal of a leptomyelolipoma. The mean time of follow-up was 18.8 ± 7.8 months. All patients with pseudotumor cerebri and subcutaneous lumbar CSF fistula and all but 1 of the patients with a cranial CSF fistula improved without further therapy. Twelve of the 16 patients with communicating hydrocephalus improved and did not require other shunt procedures. There was one shunt infection, one wound dehiscence that led to shunt removal, and one shunt migration into the spinal canal. Shunt obstruction that led to revision of the shunt occurred on three occasions in 2 patients. The shunt functioned in only 1 of 4 infants under 4 months of age.
Von Hippel-Lindau Disease with Multiple Manifestations
Authors: Hubschmann Otakar R. , Vijayanathan T. , Countee Roger W.
Published: May 2010

The association of a recurrent cerebellar hemangioblastoma, retinal angioma, pheochromocytoma, renal carcinoma, and multiple renal and pancreatic cysts in one patient is reported, and the pertinent diagnostic studies are discussed briefly. Awareness of the possibility of late manifestations of various components of this syndrome in patients treated successfully for cerebellar hemangioblastoma will lead to their early identification and successful surgical treatment. Genetic counseling for patients affected by this syndrome and their families is recommended.
Intracranial Hemorrhage Associated with Meningioma
Authors: Lazaro Reynaldo P. , Messer Henry D. , Brinker Ray A.
Published: May 2010

Intracranial hemorrhage developed in two patients with meningioma without other apparent risk factors predisposing to hemorrhage. Bleeding has been reported to be associated with meningiomas regardless of the sex or age of the patient or the location or histological nature of the tumor. It can occur acutely without antecedent symptoms, often masking the tumor. The mechanism of hemorrhage is not clear. The complication has not been emphasized in the neurological literature and, although rare, should be considered in the differential diagnosis of intracranial hemorrhage.
Benign Traumatic Intracerebellar Hematoma
Authors: Pozzati Eugenio , Piazza Giancarlo , Padovani Roberto , Gaist Giulio
Published: May 2010

Prompt surgical intervention is thought to be necessary in patients with traumatic intracerebellar hematoma. The case reported here ran a benign course without operation. Pertinent serial computed tomographic scans are presented. It is concluded that not all traumatic hematomas of the cerebellum require operation.
Ventral Spinal Tumor
Authors: Memon Muhammed Yacob , Schneck Lawrence
Published: May 2010

We are reporting a case of a ventrally placed intradural meningioma at the C-7, T-1 level that was shown clearly on a computed tomographic scan without the use of metrizamide. This greatly facilitated the planning of our posterolateral approach, which permitted a complete removal of the tumor with minimal manipulation of the spinal cord.
Microsurgery of the Third Ventricle: Part 2
Authors: Rhoton Albert L. , Yamamoto Isao , Peace David A.
Published: May 2010

The operative approaches to the 3rd ventricle are divided on the basis of whether they are suitable for reaching the anterior or posterior part of the 3rd ventricle. The approaches suitable for lesions within or compressing the anterior portion of the 3rd ventricle are the trans-sphenoidal, subfrontal, frontotemporal, subtemporal, anterior transcallosal, and anterior transventricular. The approaches suitable for reaching the posterior portion of the 3rd ventricle are the posterior transcallosal, posterior transventricular, occipital transtentcrial, and infratentorial supracerebellar. Considerations important in selecting one of these approaches are reviewed.
Technique for C-1, C-2, and C-3 Fixation in Cases of Odontoid Fracture
Authors: Six Eric , Kelly David L.
Published: May 2010

A technique for fixation of C-1, C-2, and C-3 for odontoid fractures is described. Fixation wires between the laminae of the atlas and the spinous process of the axis maintain the atlantoaxial alignment. Kirschner wire pins through the spinous processes of C-2 and C-3 act as reinforcing bars for a methyl methacrylate fusion. (Neurosurgery 8:374-377, 1981)
Cerebellar Infarction with Associated Acute Hydrocephalus Due to Vertebral Artery Occlusion in a Child
Authors: Bergen Barry J. , Batnitzky Solomon , Morantz Robert A. , Price Hilton I.
Published: May 2010

Vertebral artery occlusion due to spontaneous rotation of the head with resultant cerebellar infarction and acute hydrocephalus occurred in a 9½-month-old child. The clinical and radiological findings are described, and a brief review of the literature is given.
Klüver-Bucy Syndrome and Herpes Encephalitis
Authors: Chutorian Abe M. , Antunes Lobo J.
Published: May 2010

A case of Klüver-Bucy syndrome that developed after biopsy-proven herpes encephalitis is presented. The pathophysiology of the syndrome is discussed. The evolution of the disease in our case suggests that the syndrome, as in the animal model, may in some cases be transient.
Hypertrophic Neurofibrosis with Onion Bulb Formation in an Isolated Element of the Brachial Plexus
Authors: de los Reyes R. A. , Chason J. L. , Rogers J. S. , Ausman J. I.
Published: May 2010

A patient with hypertrophic neurofibrosis limited to the posterior cord of the brachial plexus is reported. The clinical and pathological features of this entity and the published experience to date are reviewed.
Microsurgical and Standard Removal of the Protruded Lumbar Disc
Authors: Wilson Donald H. , Harbaugh Robert
Published: May 2010

The operation of lumbar discectomy has been improved steadily since its introduction by Mixter and Barr in 1934. The present standard operation represents an accumulation of techniques that became available to succeeding generations of neurosurgeons. The addition of microsurgical technique may be the most recent means to refine the process of lumbar discectomy. One hundred cases of microsurgical discectomy were compared to the same number of standard operations, all performed by one surgeon and analyzed by another. The patient profiles were the same; the operative results showed that the standard discectomy was of good quality and that microsurgical discectomy could equal it; in comparing postoperative results, however, microsurgical discectomy was superior to the standard operation: patients returned to their usual activities in half the time. The advantage of the microsurgical technique is its capacity to preserve better the integrity of normal tissue and to impose less trauma on the body. From this analysis, we conclude that microsurgical discectomy represents a small but significant refinement of standard discectomy.
Development of Intracranial Saccular Aneurysms
Authors: Salar Giuseppe , Mingrino Salvatore
Published: May 2010

The authors report two patients with an aneurysm of the carotid siphon who underwent cervical carotid artery ligation. After many years these patients showed evidence of an aneurysm of the contralateral intracranial internal carotid artery. Possible congenital, arteriosclerotic, and mechanical factors causing aneurysm enlargement are discussed.
Visual Loss from Pituitary Tumor Masked by Optic Nerve Drusen
Authors: Lowder Careen Y. , Tomsak Robert L. , Zakov Nicholas Z. , Hahn Joseph
Published: May 2010

A case of optic nerve drusen and progressive loss of central visual acuity is reported. Despite the presence of optic nerve drusen. the loss of central visual acuity that cannot be explained by a retinal abnormality is a strong indication for further neuro-ophthalmological evaluation.
Hyperprolactinemia, Hypopituitarism, and Chiasmal Compression Due to Carcinoma Metastatic to the Pituitary
Authors: Leramo O. B. , Booth J. D. , Zinman B. , Bergeron C. , Sima A. A. F. , Morley T. P.
Published: May 2010

Carcinoma metastatic to the anterior pituitary gland may simulate prolactinoma. We are reporting a case of chiasmal compression and hyperprolactinemia caused by metastatic adenocarcinoma.
Cardiopulmonary Monitoring during Graded Cervical Internal Carotid Artery Occlusion
Authors: Pritz Michael B.
Published: May 2010

The intravascular volume and cardiac status of two patients who were thought to be at high risk to develop ischemic symptoms while undergoing graded cervical internal carotid artery occlusion were monitored by a dye dilution technique. Based on information obtained from this multivariable quantitative cardiopulmonary monitoring, measures were taken to maintain normo- to hypervolemia and to maximize cardiac performance. These medical adjuncts were thought to decrease the possibility of ischemic deficits while gradual occlusion of the internal carotid artery was being performed.
Metrizamide Computed Tomographic Cisternography for the Diagnosis of Occult Lesions of the Hypothalamic-Hypophyseal Axis in Children
Authors: Pang Dachling , Rosenbaum Arthur E. , Wilberger James E. , Gutai James P.
Published: May 2010

In children, hypothalamic-hypophyseal syndromes such as diabetes insipidus, precocious puberty, growth retardation, and panhypopituitarism can be due either to structural lesions or to functional disorders of the cerebral endocrine complex. When clinical and endocrinological parameters fail to distinguish between these etiologies, neuroradiographical diagnosis becomes extremely important. Although conventional intravenously enhanced computed tomography (IVCT) is satisfactory for the diagnosis of lesions larger than 1 cm, metrizamide CT cisternography (MCTC) greatly improves the diagnostic yield for smaller juxtapituitary masses in the suprasellar cistern, clearly defines their sizes and relationships with contiguous structures, and definitively confirms the diagnosis of empty sella syndrome. Six patients with endocrinopathies and normal or ambiguous IVCT findings are presented to illustrate how MCTC can influence their management and outcome without the patient discomfort and technical complexity associated with pneumoencephalography.
Delayed Complications of Craniocerebral Trauma
Authors: Shallat Ronald F. , Taekman Michael S. , Nagle Richard C.
Published: May 2010

A young man incurred a head injury with transiently impaired consciousness, multiple skull fractures, and monocular blindness. After 3 weeks he developed an intracerebral hemorrhage, which resolved without operative intervention. One week later he presented with massive epistaxis from a traumatic aneurysm of the right cavernous carotid artery, which extended into the sphenoid sinus. This was treated successfully by gradual occlusion of the carotid artery. Theories of the pathogenesis of these lesions as well as the rationale for treatment are discussed.
Intraventricular Tension Pneumocephalus as a Complication of Paranasal Sinus Surgery
Authors: Davis Dudley H. , Laws Edward R. , McDonald Thomas J. , Salassa John R. , Phillips Lawrence H.
Published: May 2010

A case of intraventricular tension pneumocephalus occurring as a complication of paranasal sinus surgery is presented. The pathophysiology of tension pneumocephalus is discussed and emphasis is placed on the potentially life-threatening increase in intracranial pressure that occurs. Tension pneumocephalus requires prompt diagnosis and treatment.
Management of Clotted Aneurysm of the Vein of Galen
Authors: Dean David F.
Published: May 2010

Nine clotted vein of Galen aneurysms have been reported. The author reports a case in a 4-month-old hydrocephalic male infant who underwent biopsy and drainage of the aneurysm. The case had been diagnosed as an avascular mass on a computed tomographic scan. There is a 2-year follow-up period on this patient. The literature on clotted aneurysms of the vein of Galen is reviewed.
Spinal Subdural Hematoma Associated with Anticoagulant Therapy in a Patient with Spinal Meningioma
Authors: Toledo Ezra , Shalit Mordechai N. , Segal Ricardo
Published: May 2010

A case of spontaneous subdural hematoma inthe cervicothoracic region associated with a small meningioma in a patient on anticoagulant therapy is presented. The neurological complications of anticoagulant therapy are discussed briefly. Progressive neurological deterioration in a patient on anticoagulant therapy should prompt the performance of an emergency myelogram and a possible laminectomy in spite of the potential risks of these procedures. Intraspinal bleeding occurs more frequently in the form of an epidural hematoma, but the clinical presentation may not allow differentiation from a subdural hematoma. The possible causal relation between the asymptomatic spinal meningioma, the anticoagulant therapy, and the formation of the subdural hematoma is discussed.
Gliomas of the Septal Area in Children
Authors: Page Larry K. , Clark Ronald
Published: May 2010

abstract

Five patients presented at 2 to 20 years of age with low grade gliomas: one ependymoma, one oligodendroglioma, and three astrocytomas. These tumors are thought to have arisen from the multipotential cells in the subependymal plate of the supracommissural part of the septal area. The clinical presentation, treatment, and long term survival are discussed.
Combined Transoral and Median Labiomandibular Glossotomy Approach to the Upper Cervical Spine
Authors: Arbit Ehud , Patterson Russel H.
Published: May 2010

abstract

A surgical approach to the clivus and anterior spine from C-1 to the upper part of C-5 is described. It is a direct approach that provides a wider and longer exposure than does the transoral approach. Despite the seemingly radical incision, the cosmetic deformity and functional loss are minimal. This approach is useful for the surgical treatment of a variety of processes that are situated ventral to the upper cervical spinal cord and the cervicomedullary junction.
Facial Pain Associated with a Middle Fossa Arachnoid Cyst
Authors: Martuza Robert L. , Ojemann Robert G. , Shillito John , Wepsic James G.
Published: May 2010

abstract

Two cases of anterior middle fossa arachnoid cyst associated with facial pain are reported. In one case a cystoperitoneal shunt provided pain relief: in the other case, no operation was necessary. A discussion of the origin, evaluation, and treatment of arachnoid cysts is presented.
Extramedullary Hematopoiesis Causing Spinal Cord Compression
Authors: Pile-Spellman John , Adelman Lester , Post Kalmon D.
Published: May 2010

abstract

A case of compressive myelopathy secondary to extramedullary hematopoiesis is presented. The similarities and differences between this disorder and myelopathy secondary to metastatic disease are discussed. If diagnosed early, this condition should improve with treatment.
Use of Anticoagulants, Electroencephalographic Monitoring, and Barbiturate Cerebral Protection in Carotid Endarterectomy
Authors: Gross C. E. , Adams H. P. , Sokoll M. D. , Yamada T.
Published: May 2010

abstract

This paper describes a treatment protocol for threatened stroke in patients amenable to carotid endarterectomy. The protocol includes the use of perioperative anticoagulation, intraoperative electroencephalographic (EEG) monitoring, and hypertension or barbiturates to protect the brain against documented ischemia intraoperatively. The rationale and methods for protecting the patient from the threat of thromboembolism and cerebral ischemia during each of the periods of specific risk are discussed. The most unique feature of this protocol is the use of thiopental-induced EEG burst suppression for ischemia unresponsive to hypertension during carotid clamping, which has obviated the use of a potentially dangerous and cumbersome in-line arterial shunt.
Delayed Sciatic Palsy after Total Hip Replacement
Authors: Edwards Michael S. , Barbaro Nicholas M. , Asher Stephen W. , Murray William R.
Published: May 2010

abstract

A 33-year-old woman with a 22-year history of juvenile rheumatoid arthritis developed right lower extremity sciatica 32 months after total hip arthroplasty. Physical examination and electromyography localized the abnormality to the sciatic nerve proximal to the midthigh level, involving the branch to the short head of the biceps femoris muscle. At surgical exploration, a sharp spur of methyl methacrylate, used to cement the acetabular prosthesis to the acetabulum, was found to have eroded through the lateral half of the sciatic nerve. The sciatica was relieved by neurolysis. The etiology of sciatic neuropathy after total hip replacement is reviewed.
Neurinoma of the Abducens Nerve
Authors: Bing-huan Chen
Published: May 2010

abstract

A patient presented with signs of increased intracranial pressure and a right 6th nerve paresis. The diagnostic evaluation with ventriculography indicated a tumor of the right cerebellopontine angle. At operation a neurinoma arising from the right 6th nerve was encountered. Postoperatively the patient recovered function in her 6th nerve.
Congenital Inclusion Dermoid Cyst of the Anterior Fontanel in a Japanese Infant
Authors: Yuasa Hiroshi , Tokito Sumitaka , Izumi Kazuo , Oyama Mitsuru
Published: May 2010

abstract

We report an 8-month-old Japanese female infant with a congenital inclusion dermoid cyst of the anterior fontanel. At operation it was located beneath the pericranium. The analysis of the fluid contents of the cyst and the histological findings are described.
Comparison of Percutaneous Radiofrequency Gangliolysis and Microvascular Decompression for the Surgical Management of Tic Douloureux
Authors: Burchiel Kim J. , Steege Timothy D. , Howe John F. , Loeser John D.
Published: May 2010

Forty-two patients with tic douloureux underwent posterior fossa craniectomy and microvascular decompression (MVD) or partial rhizotomy of the trigeminal nerve and were followed an average of 25 months after operation. Thirty-six patients were found to have anatomical distortion of the nerve by an artery, vein, bony prominence, or a combination of factors, and 30 patients (83%) of this group have remained pain-free postoperatively. Six patients had no discernible pathological condition at the time of operation and underwent partial trigeminal rhizotomy. No patient underwent repeated MVD or rhizotomy, although 4 patients whose pain recurred after MVD underwent rhizotomy at a second operation. Eight of the 10 patients treated by rhizotomy are currently pain-free. The overall success rate of the entire group is 90%~2% experienced a complication, and there was 1 perioperative death. Seventy-eight patients with tic douloureux who underwent 92 percutaneous radiofrequency trigeminal gangliolysis (PRTG) procedures were evaluated an average of 56 months postoperatively. Sixty-eight per cent of these patients when evaluated 1 year postoperatively were pain-free. However, only 35% of the PRTG procedures resulted in continued pain relief 5 years after operation. Twelve of the 78 patients (15%) required repeat gangliolysis because of recurrent tic pain. Considering all 78 patients treated with 92 PRTG procedures, 64% were pain-free at follow-up examination. PRTG was associated with an 8% risk of complications, which included anesthesia dolorosa, corneal anesthesia with keratitis, and significant facial paresthesias. Both PRTG and MVD have advantages. MVD should be considered because: (a) it attacks what is believed to be the primary etiology of tic douloureux, (b) the trigeminal nerve is preserved, (c) postoperative pain relief does not depend upon the production of sensory deficit, and (d) it may have a greater potential for producing long-lasting pain relief. However, PRTG has other advantages: (a) it avoids the risks of craniectomy, (b) it is repeated easily if tic pain recurs, (c) morbidity is minimal and therde is essentially no risk of mortality, and (d) it is much less expensive.
Multiple Meningiomas Evaluated by Computed Tomography
Authors: Lusins John O. , Nakagawa Hiroshi
Published: May 2010

There were 15 cases of multiple meningiomas in a consecutive series of 168 cases of meningioma studied by computed tomography during the last 5 years. This incidence of 8.9% is significantly higher than the 1 to 3% incidence reported previously. A brief clinical survey of the 15 cases and a description of the location of the meningiomas as demonstrated by computed tomography are presented. The possible cause of the higher incidence and various theories of the etiology of multiple meningiomas are explored.
Pathogenesis and Prophylaxis of Postlaminectomy Deformity of the Spine after Multiple Level Laminectomy
Authors: Yasuoka Shozo , Peterson Hamlet A. , Laws Edward R. , MacCarty Collin S.
Published: May 2010

The pathogenesis of postlaminectomy spinal deformity and instability in children was evaluated by reviewing appropriate roentgenographic findings. First, we reviewed spine roentgenograms of patients below 40 years of age who underwent spinal fusion for deformity and instability of the spine developing after a multiple level laminectomy. Two types of deformity were recognized on the roentgenograms: increased mobility between the vertebral bodies and wedging deformity of the ventral aspect of the vertebral bodies. Second, we did a follow-up study of another group of patients who had undergone laminectomy. We found the same two types of deformity in children, but not in adult patients. The incidence of deformity was higher after laminectomies of the cervical or cervicothoracic region than after lumbar laminectomies. Our data suggest that postlaminectomy spinal deformity can develop in children without irradiation or facet injury. The deformity is due to a wedging change in the cartilaginous portion of the vertebral body and to the viscoelasticity of ligaments in children. When treatment of this complication becomes necessary, anterior fusion may be effective in arresting progression. Prophylactic measures against the development of deformity are discussed. Our hypothesis concerning the mechanism of development of this complication supports the rationale of osteoplastic laminar resection and reconstruction instead of laminectomy, particularly in the management of children.