bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of the Infratentorial and Transtentorial Approaches to the Pineal Region
Authors: Reid William S. , Clark Kemp W. 
Published: May 2010

Abstract
During the past 10 years, two different operative approaches to the pineal region have been recommended by different authors. Numerous reports have appeared in the literature, indicating the safe use of one or the other of these two techniques for the excision of masses in the pineal region. This paper reports experience with both techniques in the treatment of 15 patients with mass lesions in this area. Four patients underwent a supracerebellar infratentorial approach and 11 patients underwent an occipital transtentorial approach to the pineal region. These two approaches are compared in terms of anatomical exposure, technical difficulties, and real or potential complications. The authors prefer the occipital transtentorial approach in dealing with lesions in the pineal region.
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Authors: Story Jim L. , Brown Willis E. , Eidelberg Eduardo , Arom Kit V. , Stewart James R. 
Published: May 2010

Abstract
A right proximal external carotid to distal middle cerebral artery bypass with a prosthetic tube graft was performed in a patient with intermittent cerebral ischemia due to middle cerebral artery stenosis. The patient was relieved of his symptoms, and he was neurologically normal 3 months after operation. Angiography 3 months postoperatively revealed flow through the graft and excellent filling of the middle cerebral circulation, both retrograde and antegrade. Early results suggest that an expanded polytetrafluoroethylene graft may be useful as a vascular conduit if suitable autogenous vessels are unavailable or have failed.
Anterior Pituitary Function before and after Trans-sphenoidal Microsurgical Resection of Pituitary Tumors
Authors: McLanahan Scott C. , Christy James H. , Tindall George T. 
Published: May 2010

Abstract
Anterior pituitary lobe function was measured pre- and postoperatively in 40 patients with pituitary tumors who were managed surgically by the trans-sphenoidal approach. Of 23 patients with normal anterior lobe function preoperatively, 21 (91%) were normal postoperatively. Of 17 preoperatively impaired patients, 7 (40%) regained normal function, 3 (18%) improved, 4 (24%) remained the same, and 3 (18%) were further impaired by the surgery. In this small series, the likelihood of recovery of pituitary function varied inversely with the degree of preoperative impairment and the size of the tumor, suggesting that more aggressive surgical management of small, minimally symptomatic pituitary tumors is justified.
Cerebral Cysticercosis
Authors: Schultz Thomas S. , Ascherl George F. 
Published: May 2010

Abstract
Six cases of cerebral cysticercosis have been diagnosed at the Neurological Institute of New York during the past 18 years. Three recent cases are discussed, with emphasis on the variability of signs and symptoms and the best available diagnostic techniques. One must have a high index of suspicion when evaluating patients who have immigrated to the United States from endemic areas, although the disease may be acquired through food contaminated by carriers in nonendemic areas. Conventional radiography (e.g., plain films and pneumography) and, more recently, computerized tomography are the most effective tests to confirm this diagnosis. Cerebrospinal fluid and serum eosinophilia and indirect hemagglutination titers are nonspecific but occasionally helpful. Therapy is currently confined to surgical excision of lesions where possible and symptomatic treatment otherwise.
Alterations in the Distribution of Water, Sodium, Potassium, and Chloride in Brain during the Evolution of Ischemic Cerebral Edema
Authors: Bremer Alfonso M. , West Charles R. , Kazuo Yamada 
Published: May 2010

Abstract
Experimental regional cerebral ischemia in the territory of the middle cerebral artery (MCA) in a primate (Macaca mulatta) was produced by selective embolization of the internal carotid artery bifurcation. Determinations of tissue dry weight (percentage) and tissue sodium, potassium, and chloride on samples from the affected and contralateral hemispheres were carried out periodically until 48 hours after the onset of focal cerebral ischemia. Samples from the cortex supplied by the occluded MCA showed excesses in water content, increases in sodium, and decreases in potassium as early as 3 to 4 hours after occlusion. Hemispheric swelling became apparent after 4 to 5 hours, with obvious “gray matter edema.” However, only minimal to moderate increases in the water content of the subcortical white matter (without change in electrolytes) were observed in the same brain sections. Subcortical white matter samples from the affected MCA territory showed gradual increases in water content at 12, 24, and 48 hours, but definite increases in sodium and decreases in potassium were not observed until 24 to 48 hours of ischemia. During this late phase, the “gray matter edema” remained unchanged or underwent partial resolution. Our results agree with data derived from morphological studies suggesting that ischemic cerebral edema develops in a diphasic fashion, with a primary phase of early “gray matter edema” evolving to a secondary phase of late “white matter edema.”
Transoral Exposure of the Atlantoaxial Region
Authors: Apuzzo Michael L. J. , Weiss Martin H. , Heiden James S. 
Published: May 2010

Abstract
A broad spectrum of disease entities affects the atlantoaxial-clival region. This area is readily accessible through a transoral approach, which offers capabilities for canal decompression and fusion. A case is reported that required transoral odontoidectomy with concurrent excision of an osteophyte from the base of an ununited odontoid fracture. Operative preparation, technique, and postoperative management are described in detail. The advantage and applications of the procedure are discussed.
Traumatic Anterior Atlanto-occipital Dislocation
Authors: Powers Barry , Miller Michael D. , Kramer Richard S. , Martinez Salutario , Gehweiler John A. 
Published: May 2010

Abstract
The five cases of atlanto-occipital dislocation reported in the world literature are reviewed, and four additional cases are presented, including two survivors. The pathological anatomy of this potentially catastrophic injury and its management are briefly discussed. Because immediate recognition of the atlanto-occipital dislocation is critical to proper treatment and because the neurological findings are extremely varied, a new radiographic criterion for its identification has been developed.
Autogenous Skull Cranioplasty
Authors: Prolo Donald J. , Burres Kenneth P. , McLaughlin William T. , Christensen Alexander H. 
Published: May 2010

Abstract
Every craniotomy requires immediate replacement of a fresh autograft of skull or, in the presence of cerebral swelling, delayed reimplantation of preserved autogenous skull. Resumption of osteogenesis, the index of viability, determines the effectiveness of these segments of calvaria in protecting the brain and restoring skull conformity. The cellular response in skull replaced either at the end of craniotomy or after frozen preservation was studied by light and fluorescence microscopy, skull roentgenograms, and radionuclide scintigraphy. In 5 patients eventual total remodeling of skull was found at the time of a second craniotomy performed from 1 to 19 years after the first. In 12 patients skull sections removed aseptically at craniotomy were frozen and stored for 1 to 35 months at −20°C in bacitracin. This cytotoxic preservative method fixed the tissue, which appeared unchanged on light microscopy and was sterile on bacteriological and fungal cultures. In 53 patients who underwent autogenous cranioplasty with skull stored frozen for 3 weeks to 19 months, 48 operations were totally successful. Complications included infections in 2 patients, resorption in 2 infants, and incomplete restoration in 1 adult. In 10 patients the sequential dynamics of skull revitalization were found to be: revascularization, resorption, and accretion. The repair of membranous skull is similar to that of endochondral bone of the skeleton. Skull is metabolically intensely active after reimplantation and is the ideal material for cranioplasty.
Cerebral Arterial Spasm
Authors: Allen George S. , Banghart Suzanne B. 
Published: May 2010

Abstract
We performed in vitro experiments with a small volume chamber to determine the inhibitory effect of nifedipine on serotonin-, phenylephrine-, and potassium-induced contractions of canine basilar and femoral arteries. Nifedipine, an inhibitor of the influx of extracellular calcium into smooth muscle cells, was found to be a sensitive inhibitor of contractions of the basilar artery induced by all three agents. In contrast, nifedipine did not significantly inhibit the serotonin- and phenylephrine-induced contractions of the femoral artery but did inhibit potassium-induced contractions of the femoral artery. Calcium-induced contractions of the basilar artery were also inhibited by nifedipine. These experiments demonstrate a relatively selective effect of nifedipine on the basilar artery, and a mechanism to explain this selective effect is postulated.
Cerebral Arterial Spasm
Authors: Allen George S. , Bahr Albert L. 
Published: May 2010

Abstract
In vivo experiments in dogs demonstrated angiographically that the subarachnoid injection of blood produced cerebral arterial spasm both immediately after the injection of blood and 2 days later. The sublingual administration of nifedipine reversed both the acute and the delayed cerebral arterial spasm. In addition, sublingual administration of nifedipine 20 minutes before the subarachnoid injection of blood prevented the acute spasm.
Neurogenic Tumors of the Brachial Plexus
Authors: Richardson Robert R. , Siqueira Edir B. , Oi Shizuo , Nunez Carlos 
Published: May 2010

Abstract
Two cases of solitary neurogenic tumors of the brachial plexus unassociated with von Recklinghausen's disease are presented. One patient had a malignant schwannoma. The lesion of the other patient was benign and was diagnosed pathologically as a plexiform neurofibroma. These uncommon neurogenic tumors of the brachial plexus unassociated with von Recklinghausen's disease pose diagnostic and surgical problems. The initial clinical presentation is usually that of a painless supraclavicular mass. At the time of surgical exploration, the exact site or nerve of origin cannot always be identified. If motor loss is caused by such a tumor of the brachial plexus, it usually indicates a malignant lesion and a poor prognosis. Although wide radical excision of a malignant neurogenic tumor is indicated surgically, one of our patients had an early malignant recurrence that necessitated immediate amputation.
Meningiomas of the Paranasal Sinuses, Benign and Malignant
Authors: Sadar Edward S. , Conomy John P. , Benjamin Sanford P. , Levine Howard L. 
Published: May 2010

Abstract
Three cases of paranasal sinus meningioma are presented. Their variable pathology, including angioblastic and sarcomatous changes in two of the cases, and their persistent course are emphasized.
Expanding Pneumocephalus Due to Nitrous Oxide Anesthesia
Authors: Raggio John F. , Fleischer Alan S. , Sung Yung Fong , Hoffman James C. 
Published: May 2010

Abstract
A patient who developed transtentorial herniation postoperatively was successfully treated by needle aspiration of the subdural space with removal of gas under pressure. This case demonstrates the diagnosis by CT scan and the successful management of expanding pneumocephalus due to the diffusion of nitrous oxide anesthetic into an intracranial air cavity.
Absence of Neurological and Behavioral Abnormalities after Anterior Transcallosal Operation for Third Ventricular Lesions
Authors: Winston K. R. , Cavazzuti V. , Arkins T. 
Published: May 2010

abstract
Four children who had each undergone a transcallosal operation for a lesion in the anterior 3rd ventricle were studied extensively for behavioral abnormalities of the type that might follow a disruption of the corpus callosum. No such abnormalities were found. The operative technique used in these children is described.
Pituitary Adenoma Presenting as Post-traumatic Oculomotor Palsy
Authors: de Araujo Luiz Carlos , Zappulla Rosario A. , Quinonez Rafael O. , Noh Jae M. 
Published: May 2010

abstract
Two cases of oculomotor palsy occurring after head injury in a patient with an unsuspected pituitary adenoma are presented. A possible explanation for the appearance of this sign is suggested. The literature on post-traumatic oculomotor palsy is briefly reviewed.
Intracranial Pressure Time Course in Primary Intracerebral Hemorrhage
Authors: Papo Isacco , Janny Pierre , Caruselli Giuseppe , Colnet Gilles , Luongo Antonio 
Published: May 2010

abstract
The course of intracranial pressure (ICP) over time was studied in 66 hypertensive and/or atherosclerotic patients harboring intracerebral hematomas. Patients with no disturbance of consciousness showed normal or only slightly elevated pressure. Conversely, most patients in deep coma exhibited high pressure with a tendency to rise further no matter what treatment was used. In the remaining patients with intermediate disturbances of consciousness, no definite correlation was found between ICP, clinical condition, and outcome. In all of the patients who underwent operation, the postoperative course of ICP over time was also studied and seemed to depend to a certain extent on the timing of the operation.
Use of Anal Sphincter Electromyography during Operations on the Conus Medullaris and Sacral Nerve Roots
Authors: James Hector E. , Mulcahy John J. , Walsh John W. , Kaplan George W. 
Published: May 2010

abstract
The mechanical activity of the anal sphincter can be translated into electrical activity and recorded on graph paper or an oscilloscope. The activity of the anal sphincter may be extrapolated to activity of the external urethral sphincter because both are striated muscles innervated by the pudendal nerve that arises from S-2, S-3, and S-4. Stimulation of these nerves causes contraction of the sphincter muscles, and a deflection of the recording device occurs. This technique was employed intraoperatively in monitoring operations on the conus medullaris and sacral nerve roots in 10 patients with spinal dysraphism (age range, 3 weeks to 15 years). Their diagnoses were tethered conus, 4; lipomeningocele, 3; spinal hamartoma, 1; syringocele, 1; and sacral arachnoiditis, 1. With general anesthesia, and the patient in the prone position, an electrode-containing anal plug was inserted or two needle electrodes were inserted into the anal sphincter muscle. The electrodes were connected to the electromyography recording stylus of the urodynamic bladder diagnostic unit. During the spinal operation, whenever a structure could not be identified clearly, it was stimulated with the disposable electrical stimulator and, if oscillations of the stylus occurred (indicating contraction of the anal sphincter), the structure was preserved. This technique permitted spinal operations in these 10 patients without changes in neurological or urological function.
Time Course of Serotonin-induced Vasoconstriction
Authors: Silverberg Gerald D. , Ross Gordon , Corbin Steven D. , New William 
Published: May 2010

abstract
Canine cerebral arterial segments tested in a tissue bath were found to escape from the vasoconstrictor effects of serotonin, the basilar segments more rapidly than the middle cerebral segments. At low doses (10−9M), serotonin caused a small, prolonged contraction, whereas at higher doses (10−6M), a more forceful phasic response was seen. Verapamil blocked the phasic portion of the response but not the low amplitude sustained portion. Increasing the bath concentration of K+, Ba++, and tetraethylammonium markedly enhanced the constrictor response of low serotonin doses and significantly inhibited escape. Potentiation of the force and duration of vasoactive amine-induced arterial constriction by small increments of extracellular K+ might be important in the prolonged vascular narrowing associated with subarachnoid hemorrhage.
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

Abstract
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

Abstract
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

Abstract
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

Abstract
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

Abstract
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

Abstract
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.