bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cephaloceles: Treatment, Outcome, and Antenatal Diagnosis
Authors: Simpson Donald A. , David David J. , White Julian 
Published: May 2010

Abstract
A series of 74 cephaloceles (17 cranial meningoceles and 57 meningoencephaloceles) is reported. Infants born with large meningoencephaloceles containing recognizable cerebral tissue usually did badly despite endeavors to conserve brain function by expanding the cranial capacity (5 cases) or decompressing hydrocephalic ventricles (9 cases). Infants with cranial meningoceles almost all did well, even when there was associated hydrocephalus. The etiological diversity of cephaloceles is emphasized. Frontoethmoidal meningoencephaloceles, which occur with noteworthy frequency in South and Southeast Asia, require separate consideration in both genetic counseling and treatment; the associated facial deformities (hypertelorism and orbital dystopia) can be corrected with a one-stage craniofacial reconstruction. Antenatal diagnosis by ultrasound is now often possible and was achieved in 4 cases; we suggest that neurosurgeons should participate in such antenatal evaluations.
Evolution and Resolution of Intracranial Bacterial (Mycotic) Aneurysms
Authors: Morawetz Richard B. , Karp Robert B. 
Published: May 2010

Abstract
Surgical therapy of bacterial intracranial aneurysms may prove difficult when multiple aneurysms are present or lesions are proximally located. Two patients underwent operation for bacterial intracranial aneurysms without resolution of their problems, in one case because of the involvement of a proximal branch of a dominant middle cerebral artery and in the other because of the presence of multiple bilateral aneurysms. Both patients underwent multiple angiographic evaluations during the course of treatment with documentation of complete resolution of their aneurysms over many months. The time course of the evolution and resolution of the bacterial intracranial aneurysms identified in the two patients is described, and antibiotic therapy and cardiac surgery are discussed.
Cerebral Hyperperfusion after Carotid Endarterectomy: A Cause of Cerebral Hemorrhage
Authors: Bernstein Mark , Fleming Ross J. F. , Deck John H. N. 
Published: May 2010

Abstract
Correction of a very high grade carotid stenosis by endarterectomy in a normotensive man was followed by the development of severe unilateral head, eye, and face pain, seizures, and on the 6th day a fatal intracerebral hemorrhage. Autopsy revealed changes in the cerebral hemisphere ipsilateral to the endarterectomy that resembled the changes seen in malignant hypertension, whereas the opposite hemisphere was normal. These changes included hypercellularity and edema of arterial and arteriolar walls, with necrosis, extravasation of erythrocytes, and exudation of fibrin. We propose that the clinical and pathological features in this case were due to relative hyperperfusion of a cerebral hemisphere in which autoregulation had been impaired because of preoperative chronic hypoperfusion with chronic maximal dilatation of its blood vessels. This state of relative hyperperfusion is probably similar to the normal perfusion pressure breakthrough that occasionally occurs after the resection of cerebral arteriovenous malformations. It is similar to the breakthrough perfusion that occurs in severely hypertensive patients and results in hypertensive encephalopathy.
Ischemic Necrosis of the Scalp after Preoperative Embolization of Meningeal Tumors
Authors: Chan Richard C. , Thompson Gordon B. 
Published: May 2010

Abstract
The authors report two patients who suffered ischemic necrosis of their scalps after preoperative therapeutic embolic occlusion of the external carotid artery and its terminal branches for highly vascular meningeal tumors. Local anesthesia, selective catheterization of the external carotid artery, and radiopaque polyvinyl alcohol and Gelfoam as embolic agents were used. The various complications of external carotid artery embolization are reviewed. The importance of preserving normal branches of the external carotid artery (especially the superficial temporal artery) during embolization and of careful design of the scalp flap to avoid ischemic necrosis is emphasized.
Spontaneous Resolution of Chronic Epidural Hematomas: Report of Three Cases
Authors: Tochio Hiroshi , Waga Shiro , Tashiro Haruhiko , Takeuchi Toukichi , Miyazaki Masao 
Published: May 2010

Abstract
We report three cases of the spontaneous resolution of a traumatic chronic epidural hematoma. The patients were young adults with only mild headache after trauma. All patients were treated conservatively because of the very mild symptoms and the time lapse of 1 to 2 weeks between trauma and our unexpected detection of the frontal epidural hematomas. Slow, spontaneous resolution of the hematoma occurred in all three cases.
Trigeminal Schwannoma in a Child
Authors: Ross Diana L. , Tew John M. , Benton Corning , Eisentrout Craig 
Published: May 2010

Abstract
A 5-year-old girl presented with headache, vomiting, flushing, ptosis, and paroxysmal tachycardia. The neurological findings were partial motor and sensory left trigeminal palsy, left conductive hearing defect, and left cerebellar deficit. The radiological and neuropathological findings were typical for trigeminal schwannoma, which is rare in childhood. The present patient is the youngest yet recorded.
Choroid Plexus Papilloma of the Cerebellopontine Angle Presenting as a Subarachnoid Hemorrhage: Case Report
Authors: Piguet V. , de Tribolet N. 
Published: May 2010

Abstract
A case of a choroid plexus papilloma of the cerebellopontine angle that was revealed by a subarachnoid hemorrhage in a 5-year-old boy is presented, Subarachnoid hemorrhage and choroid plexus papilloma in children are discussed
Modified Crossed Leg Raising Test and Sciatica
Authors: Swann Karl W. , Zervas Nicholas T. 
Published: May 2010

Abstract
A modification of the crossed leg raising test has been helpful in identifying patients with intervertebral disc disorders. Simultaneous flexion of the neck and elevation of the contralateral leg produced pain in the ipsilateral (presenting) sciatic notch in five patients with either free fragments or herniated disc found at operation. All patients were symptomfree postoperatively.
Temporary Neurological Deterioration after Extracranial-Intracranial Bypass
Authors: Heros Roberto C. , Scott Michael R. , Kistler Philip J. , Ackerman Robert H. , Conner Scott E. 
Published: May 2010

Abstract
Five patients who experienced temporary neurological deterioration after extracranial to intracranial bypass procedures are reported in detail. These patients suffered transient ischemic attacks or more prolonged deficits usually of a different nature than the preoperative symptoms. All patients had a good outcome and the spells ceased; the neurological deficits improved within a maximum of 2 weeks. Obvious causes of deterioration such as intra- or extracerebral hematomas, occlusion of a previously stenotic vessel, or graft occlusion were ruled out by computed tomography and angiography in each case. Intraoperative causes of neurological deterioration such as anesthetic effect, hypotension, and temporary occlusion of the cortical vessel or sacrifice of its small branches were not likely to be the cause of the deficits because in each case. the patient awoke satisfactorily and deterioration occurred hours to days later. In each case, postoperative angiography showed good perfusion of at least one major division of the middle cerebral territory. Anticoagulation with heparin in three patients did not change the clinical course. In one patient who was not anticoagulated, embolism could have been responsible for a single prolonged ischemic event, but in the other patients thromboembolism does not seem likely to have been responsible for the deficits. The cause of the deterioration in these patients remains unexplained. We speculate that hyperperfusion of chronically ischemic brain tissue and shifts in the watershed region resulting from the new flow pattern after bypass grafting are two mechanisms that may have been of importance in the etiology of these deficits.
Ventriculoperitoneal Shunts in High Risk Newborns Weighing under 2000 Grams; A Clinical Report
Authors: James H. E. , James H. E. , Bejar R. , Gluck L. , Coen R. , Merritt A. , Mannino F. , Bromberger P. , Saunders B. , Schneider H. 
Published: May 2010

Abstract
Fifty-three low birth weight high risk newborns who developed progressive hydrocephalus despite a trial period of intermittent lumbar punctures underwent cribside ventriculoperitoneal shunt placement. They all weighed less than 2000 g at the time of shunting (mean, 1308.6 g ± 398.2 SD). The operative procedures were performed at a mean age of 31.5 days ± 16.1 (SD). There were no deaths in this series. During the nursery stay, 14 patients required operative revisions for obstruction. The most common problem was infection, which occurred in 13 (24.5%) after the primary intervention and in another 5 of the 14 (35.7%) patients who required revision. The overall infection rate/patient was 26.9%. Shunt removal and intensive antibiotic therapy cured the infection in all but 1 patient. Premature, low birth weight newborns may undergo ventriculoperitoneal shunting, but close follow-up for complications such as infection and shunt obstruction is always required.
Spontaneous Posterior Fossa Subdural Hematoma as a Complication of Anticoagulation
Authors: Kanter Roy , Kanter Merrill , Kirsch Wolff , Rosenberg Gary 
Published: May 2010

Abstract
We report a patient in whom a spontaneous subdural hematoma developed in the posterior fossa during anticoagulation therapy for mitral valve disease. This rare complication of anticoagulation has been reported in only three other patients.
Dural Arteriovenous Malformations and Intracranial Hemorrhage
Authors: Malik Ghaus M. , Pearce Jeffrey E. , Ausman James I. , Mehta Bharat 
Published: May 2010

Abstract
Intracranial hemorrhage is seen less frequently with dural than with intraparenchymal arteriovenous malformations (A V Ms). We report 6 cases of intracranial hemorrhage among our past 10 patients with dural A V Ms. A literature search provided 27 other cases of intracranial hemorrhage from a total of 213 reported dural A V Ms. Although hemorrhage was relatively infrequent (7.5%) with dural AVMs located primarily within a major venous sinus, bleeding episodes occurred in 20 of the 39 (51%) cases of malformation outside a major sinus. There was primary leptomeningeal venous drainage in all cases with hemorrhage, and a large variceal dilatation was seen in 14 cases (42%). Dural AVMs located outside a major sinus are uncommon, and they have a propensity for serious intracranial hemorrhage.
Radical Removal of Lipomas of the Conus and Cauda Equina with Laser Microneurosurgery
Authors: James Hector E. , Williams James , Brock William , Kaplan George W. , Hoi Sang U 
Published: May 2010

Abstract
Ten patients with ages ranging from 4 weeks to 21 years presented with a subcutaneous lumbosacral mass noted at birth. After spinal high resolution ultrasonography or computed tomography to determine the extent of neural involvement and the length of the tumor mass in the spinal canal, the patients underwent operation. Rectal electro-myographic continuous monitoring was used in all for assessment of the S-2 and S-3 function during dissection. Carbon Dioxide laser microneurosurgery was used in all operations. Radiating energy was used for the subcutaneous mass removal (40 to 60 W), the intracanalicular dissection (1 to 5 W), and the intraconus dissection (1 to 3 W). A radical removal was obtained in all. Postoperative cerebrospinal fluid fistula occurred in 1 patient and was successfully treated. Wound dehiscence that healed with secondary closure occurred in 2 patients. Wound infection that required treatment with systemic antibiotics and topical therapy occurred in 1 patient. Paraplegia occurred in 1 patient. This was the single very significant complication of this series. It was thought to have occurred because of the polymer used to seal the tenuous dura mater at the time of closure. We conclude that, with carbon dioxide laser microneurosurgery, the lipomatous tumors can be removed safely from the neural structures of the conus and cauda.
Role of Computed Tomography in the Management of Vasospasm after Subarachnoid Hemorrhage
Authors: Pasqualin Alberto , Rosta Luisa , Da Pian Renato , Cavazzani Paolo , Scienza Renato 
Published: May 2010

Abstract
The role of computed tomography (CT) in the management of vasospasm from subarachnoid hemorrhage was evaluated in 242 consecutive cases with CT performed within 7 days after hemorrhage. Only 20% of these cases did not show a detectable subarachnoid hemorrhage on CT. Subsequent angiograms showed vessel narrowing in 56% of the cases; associated clinical deterioration was noted in 34% of the cases. On later CT, clear ischemic areas were detected in 20% of the cases. A strict correlation between the amount of cisternal blood and the subsequent development of vasospasm was observed: although absent or thin cisternal depositions were rarely associated with vasospasm, consistent or thick depositions were frequently linked to vasospasm (72% of the cases) and to ischemic disturbances (51% of the cases), as well as to clear ischemic areas on later CT (30% of the cases). Regarding the morphology of the cisternal blood collection, the risk of developing vasospasm was at its lowest (42%) for depositions only in the frontal interhemispheric fissure and was at its highest (79%) for depositions in multiple cisterns. The site of cisternal deposition corresponded closely to the area of ischemia on later CT. The persistence of subarachnoid blood more than 72 hours after hemorrhage probably increases the risk of vasospasm, although our data are not conclusive. The definition of a CT scan “at risk” for vasospasm—based on the previous findings—gives practical advantages: proper selection of patients in regard to timing of operation, closer observation and the possibility of prophylactic treatment in patients “at risk,” and more adequate evaluation of different therapeutic modalities for vasospasm. With regard to the last point, the incidence of vasospasm was not statistically different between two groups of patients uniformly “at risk”: the first group submitted to early operation and the second awaiting operation.
Depression of Circulating Blood Volume in Patients after Subarachnoid Hemorrhage: Implications for the Management of Symptomatic Vasospasm
Authors: Solomon Robert A. , Post Kalmon D. , McMurtry James G. 
Published: May 2010

Abstract
The result of 42 blood volume determinations made with autologous red blood cells labeled with chromium-51 are reported. The subjects consisted of 11 control patients and 25 patients with recent subarachnoid hemorrhage (SAH). The mean red blood cell volume (RBCV) and the total blood volume (TBV) for female patients after SAH were significantly lower than corresponding control values (P &lt; 0.01). No depression of blood volume was found in males as a group. Seventy-two per cent of females had below-normal RBCV and 50% had below-normal TBV. Fifteen patients demonstrated angiographic vasospasm or signs of cerebral ischemia. Only 1 patient with asymptomatic vasospasm had a below-normal RBCV or TBV, whereas 6 of 7 patients with symptomatic vasospasm had a subnormal RBCV or TBV. The mean RBCV and mean TBV for female patients with symptomatic vasospasm were significantly lower than corresponding control values (P &lt; 0.02) and lower than values for female patients with asymptomatic vasospasm (P &lt; 0.05). The data suggest that volume status may be the important differential between asymptomatic and symptomatic vasospasm. Delayed ischemic deficits can be expected to develop in patients who have both spasm of the intracranial vessels and decreased TBV. Patients with normal blood volume are far less likely to experience cerebral ischemia, even if vasospasm develops.
Osmotic Blood-Brain Barrier Modification and Combination Chemotherapy: Concurrent Tumor Regression in Areas of Barrier Opening and Progression in Brain Regions Distant to Barrier Opening
Authors: Neuwelt Edward A. , Hill Suellen A. , Frenkel Eugene P. 
Published: May 2010

Abstract
Chemotherapeutic drug delivery can be enhanced by administering drugs into the internal carotid or vertebral artery circulation after osmotic opening of the blood-brain barrier (BBB). As evidence of the clinical implications of this technique, radiographic documentation of central nervous system (CNS) tumor regression was observed in three patients concurrent with the development of new tumor nodule(s) in portions of the brain distant from the region of osmotic blood-brain barrier opening. These three patients, one with metastatic carcinoma of the breast, one with glioblastoma, and one with primary CNS lymphoma, highlight the importance of drug delivery to CNS malignancies.
Reanalysis of Central Cervical Cord Injury Management
Authors: Bose Bikash , Northrup Bruce E. , Osterholm Jewell L. , Cotler Jerome M. , DiTunno John F. 
Published: May 2010

Abstract
Early investigators indicated that conservative management was superior to operative intervention in the treatment of central cord injuries. Their clinical data suggested that operative treatment, in fact, worsened the condition. Recent experience with this clinical entity, however, indicates that in selected patients operative intervention may be of value in improving the rate and degree of motor recovery. A retrospective study of all individuals admitted to our hospital (Delaware Valley Spinal Cord Injury Center) with central cervical spinal cord injury was done (28 patients). One-half had been treated with medical therapy alone (Group I); the others were treated both medically and surgically (Group II). Medical therapy consisted of intravenous mannitol, dexamethasone, and sodium bicarbonate given during the acute phase of the injury. Both groups were immobilized using either a halo or a Philadelphia collar. Criteria for entry into the surgical group were one or both of the following: (a) failure to improve progressively after an initial period of improvement, with persistent compression of neural tissue visualized on myelography and (b) unacceptable instability of the spinal bony elements. The patients were given neurological scores based on the motor power of the major muscle groups. The stability of the spine was scored using the Panjabi-White scale. The two groups were compared using Student's t-test and the two-factor analysis of variance. There was no significant difference in initial neurological scores between the groups. The surgical groups had a higher incidence of instability of the bony elements of the cervical spine, as judged by the Panjabi-White scale. At the time of discharge, Group II had significantly improved motor scores when compared with Group I. The results indicate that operative intervention did not produce neurological worsening and may be safely applied when patients with central cord injuries meet the criteria used in the study. Although the two groups are not comparable, operative intervention provided statistically better motor recovery than did conservative therapy (P &lt; 0.05).
Postoperative Evaluation of Extracranial-Intracranial Arterial Bypass by Means of Ultrasonic Quantitative Flow Measurement and Computed Mapping of the Electroencephalogram
Authors: Hyodo Akio , Mizukami Masahiro , Kawase Takeshi , Nagata Ken , Yunoki Kazuta , Yamaguchi Katsuhiko 
Published: May 2010

Abstract
As an objective evaluation of extracranial-intracranial (EC/IC) bypass operation, we studied 10 patients with occlusive cerebrovascular disease after EC/IC bypass operation using ultrasonic quantitative flow measurement (UQFM) and the computed mapping of the electroencephalogram (CME). After the operation, to evaluate the efficacy of the bypass operation, we studied all patients by UQFM and CME before and during compression of the superficial temporal artery (STA). In a control series of cases, the change in common carotid blood flow during STA compression was not statistically significant, and the findings of CME were unchanged during STA compression. In the cases with bypass surgery, reduction of the common carotid blood flow during STA compression was obvious and statistically significant (P &lt; 0.001). Additionally, in 5 of the 10 cases, the CME findings were aggravated during STA compression. Therefore, in these 5 cases the brain with bypass seems functionally dependent upon the bypass flow. It is suggested that the EC/IC bypass is effective at least in these 5 cases. The UQFM and the CME, which are noninvasive and simple, are very useful for postoperative evaluation of EC/IC bypass grafts from a hemodynamic and functional point of view.
Perichiasmal Tumors: Diagnostic and Prognostic Features
Authors: Trobe Jonathan D. , Tao Alvin H. , Schuster Jonathan J. 
Published: May 2010

Abstract
A review of 49 tumors compressing the intracranial optic nerve, optic chiasm, or optic tract revealed that the majority of patients had symptoms and signs of visual loss predominantly affecting one eye. Seventy-seven per cent of patients had a relative afferent pupillary defect (RAPD), and 96% had a hemianopic defect in at least one eye, All patients had either a RAPD or a hemianopic defect. The junctional pattern of visual field defects was nearly as common (39%) as the classic bitemporal pattern (46%). Many fields contained a mixture of nerve fiber bundle and hemianopic defects; the hemianopias tended to obscure the coexisting nerve fiber bundle defects. Poor preoperative acuity predicted a relatively poor postoperative acuity, but 95% of the patients had 20/40 or better acuity in at least one eye after operation.
Treatment of Normal Pressure Hydrocephalus with Low versus Medium Pressure Cerebrospinal Fluid Shunts
Authors: McQuarrie Irvine G. , Saint-Louis Leslie , Scherer Priscilla B. 
Published: May 2010

Abstract
In a retrospective study, 39 patients received a low pressure (20 to 50 mm H2O) shunt and 33 received a medium pressure (55 to 85 mm H2O) shunt for the treatment of normal pressure hydrocephalus (NPH). Pre- and postoperative computed tomographic scans were obtained in 32 patients, permitting us to determine the influence of shunt pressure on ventricular size. A reduction in 3rd ventricle width was found to correlate with clinical improvement and was observed more frequently after the placement of a low pressure shunt than after the placement of a medium pressure shunt. When results were evaluated in patients who did not have advanced NPH or develop postoperative complications, gait was markedly improved in 60% of those receiving a low pressure shunt as opposed to 23% of those receiving a medium pressure shunt (P &lt; 0.05).