bluuebunny/crossref_metadata_2025_split huggingface dataset:
Needle Biopsy of Intracranial Lesions Guided by Computerized Tomography
Authors: Hahn Joseph F. , Levy Walter J. , Weinstein Meredith J. 
Published: May 2010

abstract
Biopsies can be performed directly with computerized tomography (CT) head scanners with some difficulty. The small scanning orifice does not allow enough room for needle placement; therefore, biopsy is difficult. In contrast, the scanning orifice of the CT body scanner is large enough to permit biopsies without hindrance. Over 300 CT-guided abdominal biopsy procedures have been performed at the Cleveland Clinic Foundation. We are reporting the technique and the results of 14 CT-guided brain biopsies. There were no complications in the series and an accurate diagnosis was made for 13 of the 14 patients.
Extracranial-Intracranial Arterial Bypass in the Treatment of Aneurysms of the Carotid and Middle Cerebral Arteries
Authors: Hopkins Leo Nelson , Grand Walter 
Published: May 2010

abstract
Eleven patients with lesions of the internal carotid and middle cerebral arteries that could not be treated by direct approach are presented. Major vessel occlusion was chosen as definitive therapy. Prophylactic extracranial-intracranial bypass was employed in an attempt to reduce the incidence of ischemic complications. Emphasis is placed on complications, from which several important lessons were learned. Our best results occurred in patients with carotid artery lesions treated with bypass and immediate internal carotid ligation. We believe this to be an effective and safe mode of therapy in cases in which direct approach is not feasible. The low risk and high potential benefit of prophylactic bypass justifies its use before major vessel occlusion in selected cases.
Traumatic Lesions of the Corpus Callosum
Authors: Komatsu Shinro , Sato Tomohiko , Kagawa Shigeki , Mori Teruaki , Namiki Tsuneo 
Published: May 2010

abstract
We investigated the mechanism of damage to the corpus callosum in a study of 46 brains obtained at the autopsies of patients with head injuries. After correlating the gross findings with the site of impact on the head, we think that such lesions in the corpus callosum are caused by stretching of callosal fibers and/or shearing forces in cases in which lateral movement or twisting of the brain occurs. This mechanism of the dynamic development of callosal injuries is also supported by the retraction bulb formation of axons found histologically in the corpus callosum.
Blunt Trauma to the High Cervical Carotid Artery
Authors: Batzdorf Ulrich , Bentson John R. , Machleder Herbert I. 
Published: May 2010

Abstract
Closed injuries to the neck, occasionally associated with mandibular fractures, can result in trauma to the internal carotid artery at the high cervical level opposite the uppermost cervical vertebrae. Such arterial injuries range from spasm to intimal tear with thrombus formation, medial tear, and aneurysm formation. These types of lesions may overlap. Ten patients are presented, five with traumatic carotid occlusions and five with traumatic aneurysms. The clinical diagnosis of traumatic cervical carotid occlusion may be difficult because of the absence of physical trauma to the neck. The diagnosis of aneurysm poses fewer problems. Oculopneumoplethysmography, computerized tomographic head scanning, and carotid arteriography with cross compression are the most useful diagnostic techniques. Thrombectomy should be carried out early, particularly in the presence of fluctuating neurological signs. Aneurysms that cannot be approached directly may necessitate carotid ligation.
Radiotherapy of Intracranial Astrocytomas
Authors: Scanlon Paul W. , Taylor William F. 
Published: May 2010

Abstract
In a review of 417 intracranial astrocytomas treated radiotherapeutically at the Mayo Clinic from 1960 through 1969, the well-known correlation of tumor grade with survival was verified. Totally unexpected was the finding that age was fully as important a discriminant as tumor grade. Another unexpected finding was that patients treated with biopsy only followed by radiation therapy did as well as or slightly better than those subjected to resection followed by postoperative radiotherapy. We could not verify the importance to survival of either large dose or large volume radiotherapy, which has been emphasized by some. Patients receiving less than 1400 rets did just as well as or slightly better than those receiving more than 1400 rets. With low grade astrocytomas, survival beyond 4 years was significantly worse (higher death rates) in the group receiving more than 1400 rets. This suggested the possibility of radiation damage with delayed manifestations. We also could not verify an increased effectiveness for the generally accepted use of total brain irradiation for high grade gliomas.
Abdominal Metastases of Primary Intracranial Yolk Sac Tumors through Ventriculoperitoneal Shunts
Authors: Wilson Edward R. , Takei Yoshio , Bikoff William T. , O'Brien Mark S. , Tindall George T. , Boehm Walter M. 
Published: May 2010

Abstract
Three cases of rare primary intracranial yolk sac tumor are reported. Two cases had a pineal location, whereas the third presented as a suprasellar mass. After the placement of ventriculoperitoneal shunts for relief of hydrocephalus, all of the patients developed metastases restricted to the peritoneum, as demonstrated by autopsy in one patient (Case 1) and clinical and radiographic evidence in two patients (Cases 2 and 3). The peritoneal metastases were directly associated with the death of one patient, but were successfully treated with chemotherapy in another patient, who is still alive more than 2.5 years after initial presentation. The value of ascitic fluid cytology and alpha-fetoprotein determination in the diagnosis of this complication was demonstrated in one patient. These cases emphasize the need for awareness of this mode of metastasis and its potentially lethal effect.
Ganglioglioma—Neurogliogenic Tumor Involving the Left Frontal Lobe
Authors: DiTullio Michael V. , Fried Herbert 
Published: May 2010

Abstract
A 5-year-old boy presented with a 7-month history of headache and projectile vomiting. Computerized axial tomography revealed a large, high density lesion involving the entire left frontal lobe. At operation a 330-g, apparently encapsulated, mildly cystic neoplasm was removed from the region of the left frontal operculum. Microscopic examination demonstrated moderately cellular astrocytic tissue interspersed with several large, bizarre, and occasionally binucleate ganglion cells. The pathological entity of ganglioglioma is briefly reviewed.
Gradual Carotid Artery Occlusion in the Treatment of Inaccessible Internal Carotid Artery Aneurysms
Authors: Giannotta Steven L. , McGillicuddy John E. , Kindt Glenn W. 
Published: May 2010

Abstract
The authors discuss 21 cases of large or surgically inaccessible internal carotid artery aneurysms treated with gradual occlusion of the cervical portion of the internal carotid artery. Eighty-five per cent of the patients experienced relief or marked improvement of their symptoms after treatment. Two early cases developed postligation ischemic deficits that partially resolved. After the introduction of expansion of circulating blood volume and induced hypertension as adjuncts to graded carotid occlusion, no ischemic complications occurred.
Suprascapular Entrapment Neuropathy: A Clinical, Anatomical, and Comparative Study
Authors: Rengachary Setti S. , Neff James P. , Singer Philip A. , Brackett Charles E. , Payne Nettleton S. , Tindall George T. 
Published: May 2010

Abstract
The clinical syndrome of suprascapular entrapment neuropathy is described and three illustrative cases are discussed. Diagnostic criteria for this entity are outlined.
Scalp Projection of Surgical Lesions in the Cerebral Hemispheres with the Use of Radioisotopes
Authors: Davis Ross , Smoak William 
Published: May 2010

Abstract
The extent of a brain tumor or abscess in the cerebral hemispheres can be easily projected onto the scalp by using small radioactive markers. A positive uptake by the lesion is seen on the persistence scope of the nuclear camera and can be delineated by scalp markers to define the limits of future craniotomy. This technique has been used for six tumor operations and has successfully reduced the size of the craniotomy and brain incision, as well as increasing the accuracy of localizing the tumor.
Nelson's Syndrome
Authors: Saleman Michael , Garcia Julio H. , Abbott Douglas J. , Martin Luis G. 
Published: May 2010

Abstract
We present a case of Nelson's syndrome in which the clinical, radiographic, and surgical findings are indicative of a discrete microadenoma rather than of diffuse pituitary hyperplasia. Ultrastructural analysis reveals this to be the first example of a sparsely granulated lesion in Nelson's syndrome and only the second such adrenocorticotropic hormonesecreting tumor reported. Unfortunately, there do not seem to be any firm ultrastructural features that differentiate between hyperplasia and discrete adenoma. Separation of the two entities may be important in delineating the pathogenesis and treatment of Nelson's syndrome; these are discussed.
Value of Tumor Markers in the Treatment of Endodermal Sinus Tumors and Choriocarcinomas in the Pineal Region
Authors: Haase Jens , Nielsen Kirsten 
Published: May 2010

Abstract
A case of embryonal carcinoma in the pineal region of a 17-year-old boy is presented. The tumor included elements of choriocarcinoma and endodermal sinus tumor, and the use of human chorionic gonadotropin and alpha-fetoprotein as tumor markers is discussed. The markers were demonstrated both within the tumor and in the cerebrospinal fluid (CSF) and blood. The patient was treated with a postoperative program of irradiation and cancer chemotherapy, and at follow-up examination 20 months after operation no signs of residual tumor were present. It is suggested that human chorionic gonadotropin and alpha-fetoprotein should be measured in the blood and CSF before the treatment of midline tumors.
&gt;Checkerboard Visual Evoked Response in Evaluation and Management of Pituitary Tumors
Authors: Gott Peggy S. , Weiss Martin H. , Apuzzo Michael , Van Der Meulen Joseph P. 
Published: May 2010

Abstract
As a routine part of the evaluation of patients with pituitary tumor, visual evoked responses (VERs) to checkerboard pattern reversal were recorded from 83 patients with tomographically documented pituitary tumor. VER tests were correlated with examinations of visual acuity, color perception, and visual fields and with computerized tomographic scan evidence of suprasellar extension of the tumor. The purpose of the VER recording was to determine the presence of visual system compression by the tumor and thus contribute to the decision of whether surgery was necessary. Each of the patients who had suprasellar extension of the tumor sufficient to produce a visual field abnormality also had an abnormal VER. In addition, some patients with suprasellar extension had normal visual fields but abnormal visual evoked responses. Thus, the VER provided earlier evidence of suprasellar extension causing visual system compromise than did conventional visual tests.
Serum Cortisol Abnormalities after Craniocerebral Trauma
Authors: Steinbok Paul , Thompson Gordon 
Published: May 2010

Abstract
Serial estimations of serum cortisol were performed in 49 patients with craniocerebral trauma. Abnormalities of serum cortisol, including alterations in diurnal rhythm and elevations of serum cortisol level, occurred in 21 patients. The frequency and severity of the abnormalities correlated with the severity of the head injury, and there was a trend suggesting that middle fossa basal skull fractures predisposed to cortisol abnormalities. A further 6 patients were studied to assess the effects of exogenous dexamethasone, and in all patients there was suppression of elevated serum cortisol levels by the dexamethasone. The findings suggest that hypercortisolemia after head injury is related to an alteration rather than an abolition of the normal feedback mechanism.
Serial Computerized Tomographic Scanning and the Prognosis of Severe Head Injury
Authors: Cooper Paul R. , Maravilla Kenneth , Moody Sarah , Clark W. Kemp 
Published: May 2010

Abstract
Serial (two or three) computerized tomographic (CT) scans were performed on a series of 58 patients with severe head injury. The protocol called for scans to be done upon admission and on Days 3 and 7 after injury. New lesions (i.e., lesions not visualized on the initial CT scans but appearing on subsequent scans) were a frequent finding, occurring in over half of all patients. For the purposes of this study a new lesion was classified as edema involving two or more lobes, extra-axial hematoma, parenchymal hemorrhage, or infarction. Significant correlation was found between good outcome and the absence of new lesions and between bad outcome and the development of new lesions (p &lt; 0.001). Several patients did well in spite of the development of new lesions, but these patients were unique in that most had small, unilateral parenchymal hematomas located at or near the frontal or temporal poles. In most cases, patients who did poorly in spite of not developing new lesions had severe injuries visualized on their initial scans (massive intracerebral hematoma, hemorrhage of the corpus callosum) or succumbed to medical complications. The pertinent literature is reviewed, and other CT findings associated with a poor prognosis are noted. The authors suggest that serial CT scanning may be used to make prognostic assessments in severely head-injured patients and may be of value in increasing the confidence in and accuracy of assessments made on clinical grounds alone.
Treatment of Subarachnoid Hemorrhage with Sodium Nitroprusside and Phenylephrine
Authors: Rothberg Charles S. , Weir Bryce , Overton Thomas R. 
Published: May 2010

Abstract
The effectiveness of simultaneous intravenous sodium nitroprusside and phenylephrine in improving the cerebrovascular disturbances and survival rate after induced subarachnoid hemorrhage (SAH) was studied in the cynomolgus monkey. We measured regional cerebral blood flow (rCBF) using the intra-arterial xenon-133 clearance technique. In our experimental animal model, SAH was associated with a persistent reduction in rCBF, elevation of cerebrovascular resistance (CVR), cerebral vasospasm for the duration of the study (150 minutes), and poor survival. For animals receiving the treatment regime (administered approximately 25 minutes after the induced SAH), rCBF remained low, CVR was high, and cerebral vasospasm was persistent. Survival in this group was the same as that observed for the untreated animals. Simultaneous administration of sodium nitroprusside and phenylephrine was ineffective in improving rCBF, CVR, cerebral vasospasm. or survival after SAH. In the control group (receiving only the treatment and not an intracranial insult), rCBF was below resting levels both during and after therapy, indicating impaired cerebral autoregulation.
Effect of Proximal Occlusion on Anastomosis Patency in Dogs
Authors: Levinthal Robert , Stern W.E. 
Published: May 2010

Abstract
This study compared the superficial temporal-middle cerebral artery (STA-MCA) anastomosis patency in animals with and without proximal embolic middle cerebral artery (MCA) occlusion. Sixteen dogs underwent STA-MCA bypass in association with silicone embolization of the MCA via an internal carotid injection. Animals re-explored 3 to 5 days postoperatively with evaluation of anastomosis patency by Evans blue injection and direct cutting of the STA demonstrated that 10 of 10 dogs with proximal MCA emboli had a patent STA-MCA anastomosis, whereas only 2 of 6 animals without an embolus lodged in the proximal middle cerebral artery had a patent connection. The likelihood of the anastomosis remaining open seems to be greatly influenced by the potential flow gradient between the extracranial and intracranial circulations.
Intravascular Use of Isobutyl 2-Cyanoacrylate: Part 1
Authors: Samson Duke , Ditmore Michael Q. , Beyer Chester W. 
Published: May 2010

Abstract
The intravascular use of the rapidly polymerizing acrylic compound, isobutyl 2-cyanoacrylate (IBC). in 10 patients with intracranial arteriovenous malformations (AVMs) is described. The monomer was introduced into each malformation at craniotomy using angiographic control and microvascular dissection technique to identify, isolate, and inject the major components of each vascular lesion while attempting to preserve normal arterial circulation. Postoperative angiography was used routinely to evaluate the results of IBC embolization. Four patients underwent the injection and immediate surgical excision of an intracranial AVM, and 6 underwent injection alone; 3 of the latter had residual malformation demonstrated on postoperative angiography, and 1 of these patients had the remnants of her malformation occluded by a second embolic procedure. There was no operative mortality nor permanent neurological morbidity. Three patients suffered transient neurological dysfunction in the immediate postoperative period.
Acromegaly
Authors: Balagura Saul , Derome Patrick , Guiot Gerard 
Published: May 2010

Abstract
The surgical treatment of 132 acromegalics is analyzed. There was an equal sex distribution among patients between the ages of 30 and 59. In the younger patients there was a preponderance of males, and the opposite situation occurred in patients older than 59 years. The overall cure rates were 58% (growth hormone (GH) &lt; 5 ng/ml) and 78% (GH &lt; 10 ng/ml). Endocrinological evidence of cure was observed most commonly in patients who exhibited preoperative GH values below 70 ng/ml.
Epidural Hematomas of the Posterior Cranial Fossa
Authors: Zuccarello M. , Pardatscher K. , Andrioli G. C. , Fiore D. L. , Iavicoli R. , Cervellini P. 
Published: May 2010

Abstract
We report eight cases of epidural hematoma of the posterior cranial fossa. The main symptoms and neurological signs are reviewed. The value of computed tomographic scanning in determining a definite diagnosis and in improving the morbidity and mortality rates of such a lesion is emphasized.
Significance of the So-Called Absorptive Reserve in Communicating Hydrocephalus
Authors: Sklar Frederick H. , Beyer Chester W. , Diehl Jan T. , Clark Kemp W. 
Published: May 2010

Abstract
Twelve patients with communicating hydrocephalus were studied with a servocontrolled lumbar infusion technique to measure net cerebrospinal fluid (CSF) absorptive capacity and resting pressure. Each patient showed a significant absorptive reserve; the rate of CSF absorption exceeded the rate of formation over a physiological range of pressure. The size of the ventricles did not correlate with either the absorptive capacity or the resting pressure parameter, or both. The data suggest that communicating hydrocephalus does not reflect a simple imbalance between the rates of CSF formation and absorption. Other factors must be of etiological importance and are considered in the discussion.
Traumatic Subdural Hygroma
Authors: Stone James L. , Lang Robert G. R. , Sugar Oscar , Moody Robert A. 
Published: May 2010

Abstract
The authors report a series of 80 cases of traumatic subdural hygroma and discuss the clinical and radiological features, management, surgical results, and pathogenesis. Changes in mental status without focal signs of brain damage were noted in over 50% of the cases. A clinical course marked by stabilization without complete recovery of neurological function was found in over 40% of the cases of “simple hygroma.” The lumbar cerebrospinal fluid often showed hemorrhage and elevation of the protein content. Skull fractures were found in 39% of the cases, and subdural hygromas were associated with cerebral atrophy, cortical contusions, subdural hematomas, and overlying epidural hematomas, and overlying epidural hematomas. The characteristic angiographic and computed tomographic scan findings are discussed, as are surgical pathology and outcome. Several theories of pathogenesis are presented. The authors advocate simple burr hole drainage as the treatment of choice. Significant reaccumulation may occur occasionally.
Emergency Twist Drill Trephination
Authors: Mahoney Brian D. , Rockswold Gaylan L. , Ruiz Ernest , Clinton Joseph E. 
Published: May 2010

Abstract
We have used the rapid progression of post-traumatic uncal herniation in spite of intensive medical therapy as the indication for twist drill trephination in the emergency department. During a 54-month period, 51 trephinations were performed on 41 patients. The trephine was placed through the temporal bone ipsilateral to the dilated pupil, and the dura mater was opened to allow partial evacuation of a hematoma. All patients subsequently underwent craniotomy, autopsy, and/or cerebral computed tomography (CT). The trephination was diagnostically accurate for the absence or presence of an extracerebral hematoma in 42 of 51 trephinations (82%). In 6 of these cases the dilated pupil responded to partial hematoma evacuation by decreasing in size. In 3 of the 6 there was a marked overall improvement in neurological status subsequent to trephination. These 3 patients later recovered to an independent functional state. Only 23 of these 41 patients (56%) with herniation profiles actually had significant extracerebral hematomas. This fact emphasizes the inadvisability of taking this type of patient directly to the operating room without a diagnostic study. A rapidly performed CT scan is the obvious first choice. However, if there is any delay in obtaining this study or when uncal herniation occurs rapidly, a twist drill trephination can be of value in diagnosing the absence or presence of a treatable extracerebral hematoma. There were no complications related to this procedure in this group.
Neurenteric Cyst
Authors: D'Almeida Antonio C. , Stewart Donald H. 
Published: May 2010

Abstract
An isolated, cervical intraspinal enteric cyst in a 40-year old man was treated successfully by laminectomy, intradural exploration, and excision. No bony anomalies were demonstrated. The pertinent literature is reviewed for embryogenic, anatomical, pathological, and clinical considerations.
Multiloculated Hydrocephalus in Infants
Authors: Albanese Vincenzo , Tomasello Francesco , Sampaolo Simone 
Published: May 2010

abstract
The clinical features and the neuroradiological appearance of multiloculated hydrocephalus that followed meningitis and ventriculitis in five newborn infants are presented. Several factors probably involved in the pathogenesis are discussed. Computed tomography is particularly helpful in the recognition of this entity and in the evaluation of its course. However, ventriculograms are advised to document the communication of the septated cavities. Of four infants treated by ventriculoatrial shunting, two died and two are mentally and neurologically disabled. Another infant, who underwent craniotomy and fenestration of the ventricular membranes, died accidentally 3 months after operation. In light of similar cases reported in the literature, the prognosis seems very poor. Craniotomy with fenestration of the ventricular septa seems a promising procedure, although further supportive evidence is needed.