bluuebunny/crossref_metadata_2025 huggingface dataset:
Dissecting aneurysms of the intracranial vertebral artery
Authors: Yamaura Akira , Watanabe Yoshiro , Saeki Naokatsu
Published: May 2009

✓ Among 86 patients with aneurysms arising from the vertebral artery or its branches, 24 had dissecting aneurysms. The patients with dissecting aneurysms were characteristically relatively young males. Twenty-one patients presented with subarachnoid hemorrhage (SAH) and three with ischemia. Severe headache or neck pain occurred in all three patients with ischemia. Five of the 21 patients with SAH and all three patients with ischemia experienced recurrent episodes. Angiography typically showed fusiform dilatation and proximal and/or distal narrowing of the affected artery. The difficulty of diagnosing this disorder is pointed out. Surgery was performed in 19 patients, the most common technique being clip-occlusion of the proximal vertebral artery. There were no postoperative deaths or rebleeding; a lateral medullary syndrome developed in three patients. The observation at surgery of intramural clot with characteristic discoloration was limited to the cases operated on within 36 days after the ictus. After this period, the aneurysm was whitish gray in color and had become firm. Of 36 other cases of vertebral dissecting aneurysm reported in the literature, 20 were operated on. The indications for surgery are discussed.
The significance of skull fracture in acute traumatic intracranial hematomas in adolescents: a prospective study
Authors: Chan Kwan-Hon , Mann Kirpal S. , Yue Chung P. , Fan Y. W. , Cheung Mary
Published: May 2009

✓ A prospective study was conducted to validate the retrospective finding that adolescents (11 to 15 years old) with skull fractures were prone to develop acute traumatic intracranial hematoma (ICH). Over a 4-year period, 1178 consecutive adolescents attended the emergency room directly, of whom 760 were discharged well and 418 were admitted. All underwent skull x-ray studies. Immediate computerized tomography (CT) scans were performed in patients with Glasgow Coma Scale (GCS) scores of less than 15, in those with radiological and/or clinical evidence of skull fracture, and whenever clinically indicated. Of the 418 admitted patients, only 26 had skull fractures; 13 of these developed ICH. Four patients without skull fracture developed diffuse brain swelling. The remaining 401 patients were discharged after observation periods of up to 48 hours. Of the 13 patients with ICH, 10 had admission GCS scores of 15; however, four deteriorated rapidly and required urgent operation, and four remained stable but were operated on due to their large ICH. Two required conservative treatment only and both made good recovery. Three patients were in coma (GCS score ≤ 8) on admission. One patient had an epidural hematoma and made good recovery after surgery. Two developed delayed ICH after operations for associated systemic injuries despite initial CT showing diffuse brain swelling only, and both died despite evacuation of the ICH. Multivariate analysis showed that skull fracture was the only independent significant risk factor in predicting ICH in adolescents (sensitivity of 100% and specificity of 97%). A routine skull x-ray study is therefore mandatory in all head-injured adolescents and, if a skull fracture is detected, immediate CT may be performed for early detection of ICH.
Management of cervical spine injuries in patients with ankylosing spondylitis
Authors: Detwiler Karl N. , Loftus Christopher M. , Godersky John C. , Menezes Arnold H.
Published: May 2009

✓ Eleven patients with ankylosing spondylitis and traumatic fracture/dislocation of the spine were identified in a retrospective review of all cases of cervical spine injury treated on the neurosurgical service over a 10-year period. Injury was most often secondary to minor trauma or a motor-vehicle accident, and the level of vertebral involvement was most frequently between C-5 and T-1. Neurological symptoms at presentation ranged from neck pain alone to complete loss of function distal to the level of injury. Initial routine treatment consisted of axial traction for realignment with the minimal weight needed to accomplish this, taking into account the flexion deformity. All patients underwent pluridirectional tomography and/or computerized tomography to delineate the exact sites of injury. Three patients died shortly after admission due to pulmonary complications. The remaining eight patients underwent early posterior stabilization and mobilization in a halo or cervicothoracic brace to achieve fusion. Neurological improvement was achieved in six of these eight cases. The experience described here supports the initiation of axial traction as initial therapy for cervical injuries followed by early surgical stabilization in patients with ankylosing spondylitis. The difficulty of maintaining spinal alignment and the devastating pulmonary problems attendant on conservative management may be obviated by early fusion.
Possible protective effect of endogenous opioids in traumatic brain injury
Authors: Hayes Ronald L. , Lyeth Bruce G. , Jenkins Larry W. , Zimmerman Richard , McIntosh Tracy K. , Clifton Guy L. , Young Harold F.
Published: May 2009

✓ Naloxone (0.1, 1.0, or 20.0 mg/kg), morphine (1.0 or 10.0 mg/kg), or saline was administered systemically intraperitoneally to rats 15 minutes prior to moderate fluid-percussion brain injury. The effects of the drugs were measured on systemic physiological, neurological, and body-weight responses to injury. The animals were trained prior to injury and were assessed for 10 days after injury on body-weight responses and neurological endpoints. Low doses of naloxone (0.1 or 1.0 mg/kg) significantly exacerbated neurological deficits associated with injury. Morphine (10.0 mg/kg) significantly reduced neurological deficits associated with injury. The drugs had no effect on neurological measures or body weight in sham-injured animals. Drug treatments did not significantly alter systemic physiological responses to injury. Data from these experiments suggest the involvement of endogenous opioids in at least some components of neurological deficits following traumatic brain injury and suggest the possibility that at least some classes of endogenous opioids may protect against long-term neurological deficits produced by fluid-percussion injury to the rat.
The importance of dopamine in the pathogenesis of experimental prolactinomas
Authors: El-Azouzi Mustapha , Hsu Dora W. , Black Peter McL. , Jolesz Ferenc , Hedley-Whyte E. Tessa , Klibanski Anne , Zervas Nicholas T.
Published: May 2009

✓ The factors responsible for the production of prolactin-secreting tumors are obscure. One hypothesis, that chronic loss of dopamine control from the hypothalamus may be associated with prolactinoma formation, was tested. Female adult Fischer 344 rats were subjected to ovariectomy and were then given subcutaneous implants of diethylstilbestrol (DES) Silastic capsules to produce lactotrophic hyperplasia. Sequential studies assessed the neuronal activity of the tuberoinfundibular dopaminergic neurons of the arcuate nucleus of the hypothalamus (A12) during and after this estrogen-induced pituitary growth. Immunocytochemical staining for tyrosine hydroxylase was used as a marker for dopamine synthesis, plasma radioimmunoassay provided plasma prolactin levels, and magnetic resonance imaging and histological studies were performed to examine the structural changes occurring in the pituitary gland. Animals were sacrificed from 3 to 67 days after DES implantation. To determine the reversibility of the estrogen-induced changes, rats were also sacrificed at different time intervals after the removal of 30-, 40-, or 60-day DES implants.

After 30 days of DES treatment, plasma prolactin levels increased 40-fold and pituitary weight increased more than threefold. Tyrosine hydroxylase immunoreactivity diminished gradually and was almost completely depleted at 30 days. Pituitary histology revealed marked prolactin cell hyperplasia. These changes were completely reversible; removal of the capsule after 30 days resulted in eventual normalization of plasma prolactin levels and pituitary size and in restoration of tyrosine hydroxylase immunoreactivity in the A12 region.

Sixty days of DES treatment produced large hemorrhagic tumors with sustained high plasma prolactin levels and an irreversibly distorted A12 area. These observations suggest that in these animals loss of dopamine regulation secondary to estrogen stimulation initially produces prolactin hyperplasia but that prolonged loss leads to adenoma formation.
Cardiac myxoma metastasizing to the brain
Authors: Ng H. K. , Poon W. S.
Published: May 2009

✓ A 55-year-old man, who had previously had a left atrial myxoma excised, developed recurrent hematomas of the left occipital lobe. Microscopic examination revealed the presence of metastatic myxoma.
Infratentorial subdural empyema: clinical and computerized tomography findings
Authors: Borovich Bernardo , Johnston Elizabeth , Spagnuolo Edgardo
Published: May 2009

✓ Infratentorial subdural empyemas are rare. The authors report three cases encountered between 1979 and 1988, representing a 3% incidence among all subdural empyemas. The common source was an ear infection. Clinical presentation encompassed a systemic febrile illness, headaches, and a stiff neck. Only one patient had an inconspicuous focal neurological deficit that suggested a cerebral location. Initial diagnosis was acute meningitis in each case. A lumbar puncture was ordered in all three cases but was actually performed in two without developing tonsillar herniation. Cerebrospinal fluid analysis confirmed the diagnosis of meningitis in one but was normal in the other. Computerized tomography allowed a precise diagnosis and localization of the pathology. All three patients received aggressive antibiotic therapy plus suboccipital craniectomy and aspiration of pus; catheter drainage was performed in two. Cultures were positive in one case and negative in the others. Two patients were cured without sequelae; the third patient was moribund at surgery and died. Although it is known that subdural empyemas may localize in the posterior fossa, only one previous report was found. Infratentorial subdural empyema may sometimes be an unrecognized companion of acute meningitis and is cured with antibiotic therapy alone.
Neuroepithelial cysts of the posterior fossa
Authors: Ciricillo Samuel F. , Davis Richard L. , Wilson Charles B.
Published: May 2009

✓ The authors report the case of a patient harboring a posterior fossa neuroepithelial cyst who presented with positional facial weakness and syncope. The patient recovered rapidly after cyst fenestration and placement of an internal cyst-cisternal shunt. The pathogenesis and principles of diagnosis and management of these rare lesions are reviewed.
Chronic intrathecal baclofen administration for control of severe spasticity
Authors: Lazorthes Yves , Sallerin-Caute Brigitte , Verdie Jean-Claude , Bastide Raymond , Carillo Jean-Pierre
Published: May 2009

✓ Baclofen, the most effective drug for treating spasticity, is a specific agonist of gamma-aminobutyric acid-B receptors, and is very abundant in the superficial layers of the spinal cord. Given orally, baclofen does not easily penetrate the blood-brain barrier, and is distributed equally to the brain and spinal cord. Direct intrathecal administration was given in order to change the distribution of the drug by preferentially perfusing the spinal cord. Eighteen patients presenting a severe spastic syndrome were treated with chronic intrathecal infusion of baclofen in the lumbar cerebrospinal fluid. After clinical preselection, 38 patients were implanted with a lumbar access port allowing long-term trials in order to determine the efficacy of baclofen therapy and the effective 12-hour dose. The 18 patients selected for chronic administration were implanted with a programmable pump. The pathology in these cases was: multiple sclerosis (6 cases), posttrauma spastic syndrome (eight cases), and (one case each) cerebral palsy, ischemic cerebral lesion, spinal ischemia, and transverse myelitis. The mean follow-up period was 18 months (range 4 to 43 months).

The clinical results were evaluated according to muscular hypertony on Ashworth's scale (changed for occurrence of painful spasms) and functional improvement. Results were better for spastic syndrome secondary to traumatic medullary lesion than for demyelinating disease. Hypertonia was improved in all cases as confirmed by the registration of the Hoffman (H) reflex. Painful muscular spasms disappeared in 14 of the 16 affected patients. Significant functional improvement was noted in nine patients and was considerable in three. The risk of side effects secondary to overdose (such as excessive hypotonia or central depression) and the absence of a specific baclofen antagonist stresses the necessity for accurate determination of the efficient dose. After an initial titration period and adjustment of the therapeutic dose, the individual doses were from 21 to 500 µg/24 hrs (mean 160 µg/24 hrs). This new conservative method is very effective, perfectly reversible, and safe when administered in conditions favorable to its use.
Infratentorial ependymomas in childhood: prognostic factors and treatment
Authors: Nazar Gregory B. , Hoffman Harold J. , Becker Laurence E. , Jenkin Derek , Humphreys Robin P. , Hendrick E. Bruce
Published: May 2009

✓ The prognostic factors and survival data were analyzed for 35 children (aged under 16 years at diagnosis) with childhood infratentorial ependymomas treated surgically at The Hospital for Sick Children in Toronto during the years 1970 to 1987. Tumor histology was reviewed individually and grouped into three categories (Categories I to III) for survival analysis. An overall 5-year survival rate of 44.6% was obtained after the exclusion of perioperative mortality. Factors associated with an improved 5-year survival rate were: total tumor removal, noninvasive tumors, Category I histology, age greater than 6 years, and absent physical signs of parenchymal invasion or lower cranial nerve involvement. The 5-year survival rate was lower when associated with Category III histology, brain-stem or cranial nerve signs, age less than 2 years, tumor invasion and/or cranial nerve involvement, and subtotal tumor removal. Clinical evidence of spinal metastases was found to be uncommon (3.1%). Surgical excision followed by radiation therapy was the primary mode of treatment for these tumors. Different approaches regarding the volume of radiotherapy to be delivered and the use of adjuvant chemotherapy are discussed.
Direct approach to arteriovenous malformations in functional areas of the cerebral hemisphere
Authors: Yamada Shokei , Brauer Floyd S. , Knierim David S.
Published: May 2009

✓ The natural history of patients with arteriovenous malformations (AVM's) suggests that serious morbidity associated with AVM's in functional areas is likely to be much greater than in silent areas. Various modes of treatment of AVM's in functional areas, including direct surgical intervention, embolization, and irradiation, have been considered to carry high risks. The authors advocate direct surgical intervention to these AVM's via a microsurgical technique based on knowledge of the hemodynamic anatomy of AVM's. The technique is designed to circumscribe the AVM without removing any surrounding cortical tissue or white matter and to preserve microcirculation in the functional area. Controlled hypotension (mean arterial blood pressure 40 to 60 mm Hg) is appropriate to enhance the safety of surgical procedures without causing metabolic and electrophysiological dysfunction. Another means to prevent neurological complications is multi-staged resection of larger AVM's, which permits obliteration compartment by compartment. This technique has the advantage of maintaining circulatory sufficiency in the functional area. There was no mortality among 56 patients who underwent the surgical procedure described. Of those, 55 patients resumed their preoperative occupation and one patient became self-sufficient.
Three-dimensional magnetic resonance images of the brain: application to neurosurgical planning
Authors: Hu Xiaoping , Tan Kim K. , Levin David N. , Galhotra Simranjit , Mullan John F. , Hekmatpanah Javad , Spire Jean-Paul
Published: May 2009

✓ Data from single 10-minute magnetic resonance scans were used to create three-dimensional (3-D) views of the surfaces of the brain and skin of 12 patients. In each case, these views were used to make a preoperative assessment of the relationship of lesions to brain surface structures associated with movement, sensation, hearing, and speech. Interactive software was written so that the user could “slice” through the 3-D computer model and inspect cross-sectional images at any level. A surgery simulation program was written so that surgeons were able to “rehearse” craniotomies on 3-D computer models before performing the actual operations. In each case, the qualitative accuracy of the 3-D views was confirmed by intraoperative inspection of the brain surface and by intraoperative electrophysiological mapping, when available.
Effect of hyperosmotic blood-brain barrier disruption on transcapillary transport in canine brain tumors
Authors: Groothuis Dennis R. , Warkne Peter C. , Molnar Peter , Lapin Gregory D. , Mikhael Michael A.
Published: May 2009

✓ Whether hyperosmotic blood-brain barrier (BBB) disruption is a technique that can be used to increase permeability of brain-tumor capillaries and thereby transiently increase drug delivery to the brain tumor is controversial. Nine virally induced brain tumors were studied in seven dogs, before and after hyperosmotic BBB disruption with 1.4 osmolar mannitol. Each dog was studied with computerized tomography (CT) after administration of the water-soluble tracer meglumine iothalamate. Each study lasted 30 minutes. A baseline CT scan and 35 to 40 additional CT scans were obtained to provide a time-related measurement of the amount of meglumine iothalamate in tissue (Am(t)), and 30 plasma samples were collected to provide the time-related measurement of meglumine iothalamate in plasma (Cp(t)). The data were analyzed by three different methods: 1) a two-compartment model and nonlinear curve fitting were used to calculate K1 (blood-to-tissue or influx constant), k2 (tissue-to-blood or efflux constant), and Vp (plasma vascular space); 2) K1 values were calculated with a two-compartment model, assuming no efflux, at the time point for each CT scan; and 3) a “tissue advantage ratio” was calculated that expressed the ratio of tissue uptake of meglumine iothalamate at each time point, comparing values before and after BBB disruption. Regardless of which method of data analysis was used, there was a marked and significant increase in transcapillary transport of meglumine iothalamate to tumor-free brain regions, while there was only a small, transient, and insignificant increase to the brain tumors. Although there were often marked increases in delivery to cortex in the same hemisphere as the tumors, there was no significant increase to brain immediately surrounding the tumors, perhaps due to altered circulatory dynamics in this region. These data raise serious questions as to the wisdom of using this technique to increase drug delivery to brain tumors in patients and strongly support the continued study of this technique in experimental brain tumors before it is used in patients.
Identical embryopathogenesis for exencephaly and myeloschisis: an experimental study
Authors: Oi Shizuo , Kokunai Takashi , Okuda Yasuhiro , Sasaki Matsuto , Matsumoto Satoshi
Published: May 2009

✓ Extensive histological and immunohistochemical studies were performed to elucidate the histopathogenesis of exencephaly induced in chick embryo as an experimental model. The findings were compared with those identified in a chick myeloschisis experimental model and in human autopsy cases. The experimental model of exencephaly in chick embryos was developed by induction with various teratogens including ethylnitrosourea, salicylate, and phenytoin. None of the cases of exencephaly was exposed to a teratogen prior to or within Hamburger and Hamilton stage 12 (45 to 49 hours postincubation), when the anterior neuropore closes. The process of overgrowth in development of exencephaly was identical to that of myeloschisis, and the results suggested neuronal overmaturation in the histological and immunohistochemical studies. Although the late-stage degenerative change with neovascularization over the exposed neural tissue (placode) was more severe in human exencephaly, the present experimental study may suggest a possible common embryopathogenesis of dysraphism. Exencephaly should be regarded as the most severe form of cranium bifidum, as myeloschisis is in spina bifida.
Alterations in Na+-K+-ATPase activity and β-endorphin content in acute ischemic brain with and without naloxone treatment
Authors: Furui Tomoo , Tanaka Issei , Iwata Kinjiro
Published: May 2009

✓ The Na+-K+-adenosine triphosphatase (Na+-K+-ATPase) activity and β-endorphin immunoreactivity were determined in rat brain at the acute stage of ischemia produced by unilateral occlusion of the middle cerebral artery (MCA). The effect of pretreatment with naloxone on these activities was also evaluated in the same model. After MCA occlusion, Na+-K+-ATPase activity was promptly reduced in the ischemic hemisphere and remained at a lower level than in the contralateral hemisphere during 90 minutes of ischemia. A single intraperitoneal 0.5-mg injection of naloxone prior to MCA occlusion attenuated the inactivation. On the other hand, β-endorphin immunoreactivity was significantly increased following ischemia. The increase was marked in the ischemic hemisphere and was also observed in the contralateral hemisphere; this increase was not affected by the administration of naloxone.

These results indicate the possibility that naloxone contributes to protecting the brain from ischemia through stabilizing the cellular membrane. The possible mechanism by which naloxone attenuates the inactivation of Na+-K+-ATPase in the ischemic brain is discussed in view of alterations of the central β-endorphin system during ischemia.
Multicellular tumor spheroids from human gliomas maintained in organ culture
Authors: Bjerkvig Rolf , Tønnesen Audun , Laerum Ole Didrik , Backlund Erik-Olof
Published: May 2009

✓ Tumor tissue from seven human gliomas was maintained in long-term agar overlay culture as multicellular organotypic spheroids. Light microscopic and ultrastructural observation of the spheroids displayed morphological features similar to those of the original tumor tissue in vivo; in this respect they were different from spheroids obtained from permanent cell lines. The spheroids contained preserved vessels, connective tissue, and macrophages, revealing a close resemblance to the conditions in the original tumor.

Flow cytometric deoxyribonucleic acid measurements of cells from the tumor spheroids and from biopsy material obtained directly from the operation revealed the same ploidy and the same amount of proliferating cells in the spheroids as in the original tumor. Fluorescence microscopy using bromodeoxyuridine (BUdR) incorporation and anti-BUdR monoclonal antibody confirmed the proliferative potential of tumor cells in the spheroids. Diameter measurements showed that the size of the spheroids from two of the tumors increased over time while in three other cases it decreased. Spheroids from the remaining two tumors showed no change in size, even after 80 days in culture. These growth data and the relatively high number of proliferating cells, as measured by flow cytometry, indicate that the degree of cell proliferation and cell loss from the spheroids are closely linked, as is the case for tumors in vivo. The culture system presented provides a valuable alternative to propagation of human tumors in animals.
Foramen magnum meningioma: transoral resection with a bone baffle to prevent CSF leakage
Authors: Bonkowski Janusz A. , Gibson Robin D. , Snape Leslie
Published: May 2009

✓ A case of meningioma situated at the anterior rim of the foramen magnum with successful removal via a transoral approach is reported. A new technique of preventing cerebrospinal fluid leakage is described utilizing fascia lata and a bone baffle without any attempt to close the dura, either by primary suture or tissue sealants.
Cobb's syndrome and its treatment with embolization
Authors: Miyatake Shin-ichi , Kikuchi Haruhiko , Koide Tomoaki , Yamagata Sen , Nagata Izumi , Minami Shun-suke , Asato Reinin
Published: May 2009

✓ A case of Cobb's syndrome, which is characterized by spinal and vertebral angiomas and a skin nevus at the same metameric level, is reported. The spinal angiomas were treated with liquid embolization using ethylene vinyl alcohol.
Radiation-induced bilateral cystic temporal lobe necrosis: reversal of memory deficit after fenestration and internal shunting
Authors: Bederson Joshua B. , Harsh Griffith R. , Walker John A. , Wilson Charles B.
Published: May 2009

✓ The authors report a case in which bilateral cystic temporal lobe necrosis developed after treatment of nasopharyngeal lymphoepithelioma with 7000 cGy of external beam radiation. The patient presented with an isolated memory deficit that was documented by neuropsychological testing. After fenestration and internal shunting of both cysts, there was striking resolution of the lesions and of the memory deficit.
The versatile frontal sinus approach to the floor of the anterior cranial fossa
Authors: Persing John A. , Jane John A. , Levine Paul A. , Cantrell Robert W.
Published: May 2009

✓ A technique to expose the anterior cranial base is described with entry through the anterior and posterior walls of the frontal sinus. Burr holes are avoided in the visible portion of the forehead. Expansion of the operative field may be accomplished, if necessary, by supplemental superior frontal or supraorbital rim osteotomy. The technique is rapid, safe, and provides excellent operative exposure and superior cosmetic results.
Intramedullary ependymoma of the spinal cord
Authors: McCormick Paul C. , Torres Roland , Post Kalmon D. , Stein Bennett M.
Published: May 2009

✓ A consecutive series of 23 patients underwent operative removal of an intramedullary spinal cord ependymoma between January, 1976, and September, 1988. Thirteen women and 10 men between the age of 19 and 70 years experienced symptoms for a mean of 34 months preceding initial diagnosis. Eight patients had undergone treatment prior to tumor recurrence and referral. Mild neurological deficits were present in 22 patients on initial examination. The location of the tumors was predominantly cervical or cervicothoracic. Radiological evaluation revealed a wide spinal cord in all cases. Magnetic resonance (MR) imaging was the single most important radiological procedure. At operation, a complete removal was achieved in all patients. No patient received postoperative radiation therapy. Histological examination revealed a benign ependymoma in all cases.

The follow-up period ranged from 6 to 159 months (mean 62 months) with seven patients followed for a minimum of 10 years after surgery. Fourteen patients underwent postoperative MR imaging at intervals ranging from 8 months to 10 years postoperatively. No patient has been lost to follow-up review and there were no deaths. No patient showed definite clinical or radiological evidence of tumor recurrence during the follow-up period. Recent neurological evaluation revealed functional improvement from initial preoperative clinical status in eight patients, no significant change in 12 patients, and deterioration in three patients. The data support the belief that long-term disease-free control of intramedullary spinal ependymomas with acceptable morbidity may be achieved utilizing microsurgical removal alone.
Percutaneous microcompression of the gasserian ganglion for trigeminal neuralgia
Authors: Lobato Ramiro D. , Rivas Juan J. , Sarabia Rosario , Lamas Eduardo
Published: May 2009

✓ The authors report 144 cases of trigeminal neuralgia treated by percutaneous microcompression of the trigeminal ganglion (PMTG). The operation was performed under short-lasting barbiturate anesthesia without endotracheal intubation. Meckel's cave was cannulated with a No. 4 Fogarty catheter and the balloon was inflated for 1 minute. The average intraluminal pressure required for adequate compression of the ganglion was about 1200 mm Hg. All patients were initially relieved of their neuralgia. In a follow-up period ranging from 6 months to 4½ years, 14 patients (9.7%) developed recurrence of pain between 10 and 35 months after surgery. Eleven patients underwent a second PMTG. All nine early failures and 10 of the 11 late recurrences occurred in cases with technical deficiencies. Most of the minor surgical complications observed were also related to avoidable technical errors. There were no anesthetic complications and no deaths.

All patients developed mild to moderate postoperative hemifacial numbness with or without objective hypesthesia. Both subjective and objective deficits gradually diminished with time and were well tolerated. One year after the operation nearly 40% of the patients still had patches of slightly decreased sensation in one or more trigeminal divisions and 16% had mild dysesthesia. Anesthesia dolorosa or keratitis was not reported. The PMTG procedure is easy to perform and requires a short operative time and a brief period of hospitalization. It is well tolerated by patients, who describe it as a totally pain-free experience. Morbidity is minimal and recurrence of neuralgia does not seem to be higher than with alternative procedures.
Management morbidity and mortality of poor-grade aneurysm patients
Authors: Bailes Julian E. , Spetzler Robert F. , Hadley Mark N. , Baldwin Hillel Z.
Published: May 2009

✓ Preliminary experience with the occasional good survival of patients in Hunt and Hess Grade IV or V with aneurysmal subarachnoid hemorrhage (SAH) led to a prospective management protocol employed during a 2½-year period. The protocol utilized computerized tomography (CT) scanning to diagnose SAH and to obtain evidence for irreversible brain destruction, consisting of massive cerebral infarction with midline shift or dominant basal ganglia or brain-stem hematoma. These patients, along with those who exhibited poor or absent intracranial filling on CT or angiography, were excluded from active treatment and given supportive care only. All other patients had immediate ventriculostomy placement and, if intracranial pressure (ICP) was controllable (≤ 30 cm H2O without an intracranial clot or ≤ 50 cm H2O in the presence of a clot), went on to have craniotomy for aneurysm clipping. Aggressive postoperative hypertensive, hypervolemic, hemodilutional therapy was subsequently employed. Of 54 patients with poor-grade aneurysms, ventriculostomy was placed in 47 (87.0%) and yielded high ICP's in the overwhelming majority, with the mean ICP being 40.2 cm H2O. Nineteen poor-grade aneurysm patients received no surgical treatment and survived a mean of 31.8 hours with 100% mortality. Thirty-five patients underwent placement of a ventriculostomy, craniotomy for aneurysm clipping and intracranial clot evacuation, and postoperative hypertensive, hypervolemic, hemodilutional therapy. The outcome at 3 months of the 35 patients who were selected for active treatment was good in 19 (54.3%), fair in four (11.4%), poor in four (11.4%), and death in eight (22.9%).

It is concluded that poor-grade aneurysm patients usually present with intracranial hypertension, even those without an intracranial clot. Based on radiographic rather than neurological criteria, a portion of these patients can be selected for active and successful treatment. Increased ICP can be present without ventriculomegaly, and immediate ventriculostomy should be performed. As long as ICP is controllable, craniotomy and postoperative intensive care can effect a favorable outcome in a significant percentage of these patients.
Treatment of patients with recurrent gliomas with cyclophosphamide and vincristine
Authors: Longee Darryl C. , Friedman Henry S. , Albright Robert E. , Burger Peter C. , Oakes W. Jerry , Moore Joseph O. , Schold S. Clifford
Published: May 2009

✓ Seventeen patients with recurrent gliomas were treated with the combination of cyclophosphamide and vincristine. All but one had previously received and failed chemotherapy. Cyclophosphamide was administered at doses ranging from 250 to 1000 mg/sq m by intravenous infusion on Days 1 and 2, and vincristine was given at a dose of 1.0 mg/sq m (2 mg maximal dose) intravenously on Day 1; cycles were repeated every 4 weeks. Clinical and radiographic improvement was observed in eight of 16 evaluable patients, and four other patients had stabilization of previously progressive disease. Four patients are alive and off treatment without evidence of recurrence for a median period of 37 months; these included an adult with a cerebral anaplastic astrocytoma now more than 51 months after therapy. Toxicity included moderately severe myelosuppression that required hospitalization in seven patients. These results indicate that the combination of cyclophosphamide and vincristine has activity in the treatment of recurrent gliomas, and warrant the use of these drugs in larger controlled studies, particularly if they can be used in conjunction with hematopoietic growth factors.
Invasion of human brain tumors in vitro: relationship to clinical evolution
Authors: de Ridder Leo , Calliauw Luc
Published: May 2009

✓ Embryonic chick heart fragments were confronted in vitro with cells from 26 freshly resected human brain tumors. The tumor-derived cells were scored according to their survival and invasiveness. Four different responses were observed: disintegration of the tumor-derived cells (Type I); survival of cells without progressive engulfing or invasion of the heart fragment (Type II); initial encircling of the heart fragment followed by invasion (Type III); and massive invasion on initial contact (Type IV). Pattern Type III or IV was seen in 11 of 14 preparations derived from malignant tumors, and pattern Type I or II was seen in seven of 10 preparations derived from benign tumors. These results suggested that “classical malignancy,” based upon the histological classification and the degree of spread in vivo, correlated with invasiveness in vitro.
Somatosensory evoked potentials and neurological grades as predictors of outcome in acute spinal cord injury
Authors: Li Chen , Houlden David A. , Rowed David W.
Published: May 2009

✓ An analysis of Motor Index score, pinprick sensory score, joint position sense score, somatosensory evoked potential (SSEP) grade in the ulnar (SSEPu) and posterior tibial (SSEPt) regions, and overall SSEP grade (mean SSEPu+t) was conducted in 36 patients with cervical spinal cord injuries to determine the relationship of these scores, both individually and in combination, to functional outcome (as determined using the Barthel Index) at 6 months after injury. The clinical and electrophysiological data were obtained on the same day within 2 weeks after injury. Nineteen patients underwent two SSEP tests 1 week apart within the first 3 weeks following injury in an attempt to identify mean SSEPu+t improvement. Somatosensory evoked potential grading was based on the presence or absence of the cortical evoked potential, the amplitude of the early cortically generated waveform (P22 or P37), and the interpeak latency across the lesion site.

Mean SSEPu+t had the strongest individual relationship with outcome (R-square 0.75, p < 0.0001) and mean SSEPu+t improvement over a 1-week interval during the first 3 weeks after injury was associated with Motor Index score improvement over a 6 month period. Joint position sense score was the best clinical predictor of outcome (R-square 0.64, p < 0.0001). Mean SSEPu+t correlated with outcome more closely than the combination of Motor Index score and pinprick sensory score. Mean SSEPu+t in combination with all three clinical indicators produced the strongest correlation with outcome (R-square 0.87, p < 0.0001).

This study confirms the prognostic value of quantitative SSEP analysis for patients with acute spinal cord injuries.
Influence of PGE2- and cAMP-modulating agents on human glioblastoma cell killing by interleukin-2-activated lymphocytes
Authors: Kuppner Maria C. , Sawamura Yutaka , Hamou Marie-France , de Tribolet Nicolas
Published: May 2009

✓ Human glioblastoma cells secrete factors, such as prostaglandin E (PGE) and transforming growth factor beta type 2, which are capable of suppressing several immune functions. The present study investigated the effect of PGE2 and agents known to increase intracellular cyclic adenosine monophosphate (cAMP) levels on 1) the induction of lymphokine-activated killer (LAK) cell activity from the peripheral blood lymphocytes (PBL) of both normal and glioma patients and on 2) the cytolytic activities of tumor-infiltrating lymphocytes (TIL's) isolated from malignant gliomas after expansion in vitro with interleukin-2 (IL-2). Cytolytic activity was measured against autologous and allogeneic tumor cells and the natural killer-resistant Daudi cell line. The results demonstrate that PGE2 and agents known to increase intracellular cAMP levels can significantly suppress the IL-2-dependent generation of cytolytic activity from the PBL of normal and glioma patients and from glioblastoma-derived TIL's. The inhibitory effects of these agents could not be reduced by higher concentrations of IL-2 or by cyclic guanosine monophosphate.

Although the suppressive effect of PGE2 was most significant during the early stages of LAK cell generation, an inhibitory effect was still evident when PGE2 was added directly to the cytotoxicity assay. Secretion of PGE2 by glioblastoma cells in vivo may regulate both the generation of an immune response and the effectiveness of adoptively transferred immune cells.
Thalamic cavernous malformation
Authors: Roda José M. , Alvarez Fernando , Isla Alberto , Blázquez Martín G.
Published: May 2009

✓ A 50-year-old man with a right hemiparesis was found to have a cavernous malformation in the left thalamus. The diagnosis was made using magnetic resonance (MR) imaging. The vascular malformation was totally removed by means of a transcallosal interhemispheric surgical approach, but the patient's neurological deficit worsened. The role of MR imaging in establishing the diagnosis is emphasized and other published cases with thalamic locations are reviewed.
Neurological deterioration in a patient with a spinal arteriovenous malformation following lumbar puncture
Authors: Awad Issam A. , Barnett Gene H.
Published: May 2009

✓ The mechanism of nonhemorrhagic neurological deterioration from spinal arteriovenous malformation (AVM) and the role of acute surgical intervention in this setting are not well understood. The case is described of a 65-year-old man who presented with a 2-year history of mild gait spasticity and vague sensory complaints affecting both lower extremities. Following a diagnostic lumbar puncture, these symptoms progressed painlessly over a 4-day period to total motor paraplegia, urinary retention, and hypesthesia in all modalities with a midthoracic sensory level. Magnetic resonance imaging showed a probable spinal AVM but no evidence of hemorrhage or cord compression. Spinal angiography confirmed the diagnosis of spinal AVM fed by radicular branches of left T-7 and T-8 segmental intercostal arteries. Drainage was via long dorsal veins caudally. Emergency laminectomy with intradural exploration was performed. There was no evidence of prior hemorrhage or focal mass effect, although the cerebrospinal fluid pressure was elevated. The dural component of the spinal AVM was excised, and its communications with the spinal cord were disconnected intradurally. Neurological function started improving within 6 hours of the patient awakening from anesthesia. He had achieved antigravity strength in every muscle group of the lower extremities by the time of discharge to a rehabilitation center 10 days after surgery. Three months postoperatively, he was ambulating with a walker and was continent of urine and stool. Possible pathophysiological mechanisms are discussed in light of the favorable response to timely surgical intervention.
Management of dural arteriovenous malformations of the anterior cranial fossa
Authors: Martin Neil A. , King Wesley A. , Wilson Charles B. , Nutik Stephen , Carter L. Phillip , Spetzler Robert F.
Published: May 2009

✓ Eight patients with dural arteriovenous malformations (AVM's) of the anterior cranial fossa are presented, and the pertinent literature is reviewed. Unlike cases of dural AVM's in other locations, sudden massive intracerebral hemorrhage was the most frequent reason for presentation. Other symptoms included tinnitus, retro-orbital headache, and a generalized seizure. The malformations were supplied consistently by the anterior ethmoidal artery, usually in combination with other less prominent feeding vessels. The lesion's venous drainage was through the superior sagittal sinus via a cortical vein; in addition, in two cases a subfrontal vein drained the AVM. A venous aneurysm was encountered near the site of anastomosis with the dural feeder in most cases, and was found in all patients who presented with hemorrhage. The AVM was obliterated surgically in six patients, with favorable results achieved in five. One patient died postoperatively from a pulmonary complication. Because of their anatomy and proclivity for hemorrhage, these vascular malformations represent a unique group of dural AVM's. Surgical management of anterior fossa dural AVM's carries low morbidity, and is indicated when the lesions have caused hemorrhage or when there is an associated venous aneurysm.
Influence of intraoperative antibiotic choice on the incidence of early postcraniotomy seizures
Authors: Michenfelder John D. , Cucchiara Roy F. , Sundt Thoralf M.
Published: May 2009

✓ Because of a suspicion that intraoperative penicillin antibiotics might be causing early postoperative seizures in craniotomy patients, a deliberate effort was initiated in 1987 to avoid these agents in favor of nonpenicillin antibiotics. This permitted a retrospective comparison of the incidence of early postoperative seizures in craniotomy patients who did and who did not receive intraoperative penicillins. Records of patients treated between July 1, 1984, and July 1, 1985, and between July 1, 1987, and July 1, 1988, were reviewed, for a total of 1316 procedures. There were no seizures in the 323 patients who underwent suboccipital craniectomy. However, among the 993 patients receiving supratentorial procedures there were 30 with seizures within the first 6 hours postoperatively, 19 of which were generalized seizures. The incidence of early seizures was 4.7% (20 cases) of the 427 patients given penicillins and only 1.8% (10 cases) of the 566 not given penicillins (p < 0.01). Since patients undergoing surgery for intractable seizures have a high incidence of early postoperative seizures (11 of 92 in this series, or 12%), creation of a subgroup eliminated these from consideration but did not alter the relationship of penicillins to early seizures (p < 0.02). The authors conclude that intraoperative (and early postoperative) penicillin antibiotic administration should be avoided, if possible, in patients undergoing craniotomy for supratentorial pathology.
Vascular anomalies associated with aneurysms of the anterior communicating artery: microsurgical observations
Authors: Ogawa Akira , Suzuki Michiyasu , Sakurai Yoshiharu , Yoshimoto Takashi
Published: May 2009

✓ Direct operations were performed on 206 patients with aneurysms of the anterior communicating artery (ACoA) using a bifrontal craniotomy and an interhemispheric approach. A total of 44 (21.4%) of these patients had vascular anomalies in the vicinity of the ACoA; these included a median artery of the corpus callosum (MACC) in 27 cases (13.1%), duplication of the ACoA in 20 (9.7%), and duplication of the A1 segment of the anterior cerebral artery in one (0.5%). A retrospective study of the angiograms indicated that diagnosis of the A1 or ACoA duplication was not possible; only 11 (41%) of the 27 MACC's were easily identified, while eight (30%) could not be diagnosed. The majority of the cases of ACoA aneurysms with MACC (81.5%) showed trifurcation of the ACoA, A2, and MACC. The operative results in the patients with MACC did not differ significantly from the results of the entire ACoA aneurysm series. From the above study it is concluded that, regardless of whether a vascular anomaly has been identified preoperatively, ACoA aneurysm surgery should be undertaken with that possibility in mind. A bifrontal craniotomy and an interhemispheric approach has the advantage of allowing for a wide operative field and the attainment of a good understanding of the vascular structures near the ACoA. It is particularly useful in cases of vascular anomaly in this region.
Clinical experience with radiofrequency and laser DREZ lesions
Authors: Young Ronald F.
Published: May 2009

✓ Dorsal root entry zone (DREZ) lesions were used to treat intractable pain due to deafferentation in 78 patients managed between 1981 and 1988. Etiology of pain included avulsion of brachial or lumbosacral plexuses (27 cases), spinal cord injury (20 cases), amputation (nine cases), post-herpetic neuralgia (16 cases), and cauda equina injury (six cases). Three different lesioning techniques were employed: a radiofrequency (rf) method using a 0.5 × 2-mm stainless steel electrode with control of electric current and duration (Group 1: 21 cases); the CO2 laser (Group 2: 20 cases); and an rf method, using a 0.25 × 2-mm stainless steel electrode with control of electrode temperature and duration (Group 3: 37 cases).

Overall, 48 (61.5%) of 78 patients received satisfactory pain relief, defined as a 50% or greater reduction in pain intensity, cessation of narcotic analgesic usage, and improvement in functional capacity. Fourteen (67%) of the 21 Group 1 patients obtained effective pain relief, compared to nine (45%) of the 20 Group 2 patients and 25 (68%) of the 37 Group 3 patients. Neurological complications including mainly ipsilateral leg weakness or loss of proprioception occurred in 52.3% of the patients in Group 1, 15% of the Group 2 patients, and 8.1% of the Group 3 patients. These results support the view that DREZ lesions may be made most effectively and safely with the rf lesioning technique associated with control of electrode temperature and duration.