bluuebunny/crossref_metadata_2025_split huggingface dataset:
Arachnoid Cyst of the Cerebellopontine Angle Manifesting as Contralateral Trigeminal Neuralgia: Case Report
Authors: Babu Ramesh , Murali Raj 
Published: April 2011

Abstract
A case of an arachnoid cyst in the cerebellopontine angle manifesting as contralateral trigeminal neuralgia is presented. Decompression and excision of the lesion resulted in total relief of symptoms. The possible causes of contralateral trigeminal neuralgia are briefly reviewed, and the surgical treatment of this entity is discussed.
Transoral Crossbow Injury to the Cervical Spine: An Unusual Case of Penetrating Cervical Spine Injury
Authors: Salvino Christopher K. , Origitano T. C. , Dries David J. , Shea John F. , Springhorn Mary , Miller Charles J. 
Published: April 2011

Abstract
The complexity of missile injuries to the cervical spine has increased as the technology that causes these injuries has become more sophisticated. Management requires adaptation of conventional neurosurgical approaches to the cervical spine in an effort to limit neurological deficit and establish stability. We report an unusual case of a 19-year-old man who suffered transoral penetration of the cervical spine by an arrow released by a crossbow at close range.
Successful Management of an Adult Lightning Victim Using Intracranial Pressure Monitoring
Authors: Lehman L. B. 
Published: April 2011

Abstract
Serious central nervous system injuries after lightning strikes are fortunately rare. Optimal neurological and neurosurgical management has not been firmly established. We describe the successful neurological resuscitation and critical care management using intracranial pressure monitoring of an adult who sustained a lightning strike. The role of intracranial pressure monitoring in this setting is discussed.
Civilian Craniocerebral Gunshot Wounds
Authors: Benzel Edward C. , Day William T. , Kesterson Lee , Willis Brian K. , Kessler Charles W. , Modling Denise , Hadden Theresa A. 
Published: April 2011

Abstract
Experience with 120 patients who incurred a gunshot wound to the head with dural penetration is presented. All of the patients were managed by a standard resuscitation protocol and assigned a clinical grade based on their level of consciousness both at the time of presentation and at 2 to 4 months after injury. Fifty patients (42%) underwent surgery. Twenty-eight patients (23%) had a good recovery, 19 (16%) were moderately disabled, 6 (5%) were severely disabled, and 67 (56%) died. All patients who were alert and awake with a normal or near normal neurological examination at the time of admission survived with a good outcome. All but 4 patients who were comatose at the time of admission died. Nine patients, however, who were not comatose at the time of admission died from potentially preventable causes. In 3 of these patients, a more aggressive diagnostic approach (including cerebral angiography) may have altered their ultimate outcome. An expeditious approach to the trauma victim with a comprehensive management scheme after injury may have altered the course in the remainder of these patients. (Neurosurgery 29:67-72, 1991)
Ossifying Fibroma in the Sylvian Fissure: Case Report
Authors: Kamei Yoshifumi , Kanno Tetsuo , Abe Masato 
Published: April 2011

Abstract
A rare case of an ossifying fibroma that developed in the sylvian fissure is reported here. During surgery, branches of the middle cerebral artery were encased in osseous tumor. The encased branches were divided and reanastomosed after the mass was removed. Postoperative angiograms demonstrated patency of the anastomosed arteries and a postoperative magnetic resonance imaging scan revealed no infarction distal to the arterial anastomoses. The authors recommend division and anastomosis of the encased arteries rather than partial removal of tumor from around the encased arteries, resulting in residual tumor being left behind. (Neurosurgery 29:120-123, 1991)
Transfalcine Approach to a Callosomarginal Artery Aneurysm
Authors: Ellenbogen Richard G. , Scott Michael R. 
Published: April 2011

Abstract
We describe a transfalcine approach to clipping and subsequently excising an expanding mycotic callosomarginal aneurysm. The patient had a devastating dominant (left) hemispheric spontaneous intracranial hemorrhage and was neurologically improving at the time of surgery nearly 2 months later. To avoid retracting the left hemisphere, we approached this left callosomarginal aneurysm from the nondominant side through the falx. The approach was straightforward, and the result was satisfactory. (Neurosurgery 29:140-143, 1991)
Association of Hypovolemia after Subarachnoid Hemorrhage with Computed Tomographic Scan Evidence of Raised Intracranial Pressure
Authors: Nelson Richard J. , Roberts Jane , Rubin Caroline , Walker Valerie , Ackery Duncan M. , Pickard John D. 
Published: April 2011

Abstract
Hypovolemic patients are more likely to suffer delayed cerebral ischemia and infarction after a subarachnoid hemorrhage (SAH). Prompt recognition and correction of hypovolemia may improve the outcome. We have identified computed tomographic (CT) scan findings that increase the probability of a patient presenting with hypovolemia soon after an SAH. The plasma volume (PV) of 25 patients admitted within 96 hours of an SAH was measured using radioiodinated serum albumin. The normal PVs were measured in an outpatient setting 6 months later or predicted from their total body water. Nine patients (36%) were found to be hypovolemic, defined as a fall in PV exceeding 10% of the normal PV (mean fall, 18 ± 2%). Sixteen patients were normovolemic or hypervolemic (mean PV, + 9 ± 2%). The basal cisterns were compressed or obliterated on the CT scans of all hypovolemic patients compared with 12.5% of normovolemic patients (chi-square, 14.52; P &lt; 0.01). The probabilities of a patient being hypovolemic if the CT scan indicated raised intracranial pressure were high: hydrocephalus, P = 0.80; compression of the basal cisterns, P = 0.82; and compression of the basal cisterns associated with intracerebral hematoma or midline shift, P = 1.00. Patients with an SAH and radiological evidence of raised intracranial pressure should be considered at particular risk for systemic hypovolemia.
Intracanalicular Acoustic Neurinomas
Authors: Samii Madjid , Matthies Cordula , Tatagiba Marcos 
Published: April 2011

Abstract
The cases of 16 patients with acoustic neurinomas confined to the intracanalicular area are presented. These represent 2.7% of the 600 patients with acoustic neurinomas consecutively operated upon at the Neurosurgical Clinic at Nordstadt Hospital during the last 8 years. The comparatively earlier onset of vestibular symptoms and signs was characteristic of this group and precipitated diagnosis. The diagnostic reliability of magnetic resonance imaging was at least equivalent to that of air computed tomographic cisternography. Complete tumor removal was accomplished via the suboccipital approach in all patients, with 100% preservation of facial nerve and facial function; the cochlear nerve was preserved anatomically in 100% of the patients and functionally in 57%. No recurrence has occurred during follow-up periods of up to 8 years in all 16 patients. A broad spectrum of the current literature is considered, and purely intracanalicular acoustic neurinomas are discussed with regard to clinical characteristics, diagnostic steps—including neuroradiological and neurophysiological approaches—and surgical treatment and results.
Long-Term Effects of Radiotherapy and Bromocriptine Treatment in Patients with Previous Surgery for Macroprolactinomas
Authors: Moberg Erik , af Trampe Eva , Wersäll Jan , Werner Sigbritt 
Published: April 2011

Abstract
The long-term effect of radiotherapy and bromocriptine treatment was retrospectively evaluated in 25 patients who had previously undergone transsphenoidal surgery for treatment of macroprolactinomas. Surgery had reduced the median serum prolactin (PRL) value from 613 Mg/l to 291 Mg/l, a reduction of 53%. Postoperative bromocriptine was administered to 21 of the 25 patients. In 14 of these patients, serum PRL values became normal or almost normal with medication. There were no radiological or ophthalmological signs of progressive tumor growth during bromocriptine treatment. Fourteen patients received postoperative radiotherapy. After withdrawal of bromocriptine in 13 of these patients an average of 7 years after radiotherapy, the median serum PRL value had further decreased by 95%. The PRL reduction was similar for all doses applied, 38 to 52 Gy. After withdrawal of bromocriptine in 8 patients not receiving radiotherapy an average of 7 years after operation, the median serum PRL level had further decreased by 75%. At follow-up, 18 additional instances of pituitary insufficiency had developed in the group receiving radiotherapy, compared with 8 cases of insufficiency in the group not receiving radiotherapy. Thus, because bromocriptine has a long-standing effect on prolactin secretion, and radiotherapy is associated with a notably high incidence of pituitary insufficiency, we propose that photon irradiation should be considered mainly for patients who are not candidates for surgical or medical treatment.
Pachymeningitis Associated with a Pulmonary Nodule
Authors: Adler John R. , Sheridan William , Kosek Jon , Linder Steven 
Published: April 2011

Abstract
The authors report a case of hypertrophic pachymeningitis, a rare cause of spinal cord compression. In this patient, dural inflammation was associated with a histologically identical pulmonary lesion. Such an association has not been described previously and supports the hypothesis that this disease is related to other connective tissue disorders.
Treatment of Cerebral Arteriovenous Malformations with a Combination of Preoperative Embolization and Surgery
Authors: Pasqualin Alberto , Scienza Renato , Cioffi Fabrizia , Barone Giovanni , Benati Aldo , Beltramello Alberto , Da Pian Renato 
Published: April 2011

Abstract
Forty-nine patients with cerebral arteriovenous malformations (AVMs) were treated with preoperative embolization followed by resection using a microsurgical approach. In 27 patients, the AVM was located in an eloquent area; in 32 patients, the volume of the AVM was over 20 cm3. Preoperatively, flow-directed embolization was performed in 10 patients (28 procedures), selective embolization with threads was performed in 35 patients (46 procedures), and a combination of flow-directed and selective embolization was performed in 4 patients (12 procedures). The percentage of reduction of the AVM volume averaged 36% after embolization. Five minor complications (transient neurological deficits, in 2 cases associated with ischemic areas on the CT scan) were observed after embolization. The interval between the last embolization and surgery was as follows: within 10 days in 7 patients; between 11 and 20 days in 3 patients; between 21 and 30 days in 10 patients; between 31 and 60 days in 11 patients; and 2 months later in 18 patients. The efficacy of this combined treatment (embolization plus surgery) was evaluated by the incidence of hyperemic complications and the clinical outcome. Hyperemic complications occurred more frequently in patients with an AVM volume greater than 20 cm3. When compared with flow-directed embolization, selective embolization was linked with decreased bleeding during surgery; postoperatively, the incidence of cerebral edema was also lower. Clinical outcome was better after selective embolization, with no occurrence of major deficits and no mortality. When the percentage of reduction of the AVM volume after embolization was 40% or more, the incidence of intraoperative hyperemic complications was lower; moreover, new permanent deficits were never observed in patients with this volume reduction. A retrospective clinical comparison of two groups of patients with similar AVM volumes (&gt;20 cm3)—those given combined treatment (n = 32) versus those treated by direct surgery alone (n = 27)—showed that intraoperative bleeding appeared to decrease in patients treated by embolization; the incidence of postoperative hyperemic complications was not different in the two groups. New major deficits and deaths were less frequent in patients treated by embolization (P= 0.05 for the incidence of major deficits); postoperative epilepsy was also less common in these patients. In conclusion, combined treatment with selective preoperative embolization and direct surgery may help the neurosurgeon in the treatment of large, high-flow AVMs, reducing the risks connected with their surgical removal. (Neurosurgery 29:358-368, 1991)
Brachytherapy: A Viable Alternative in the Management of Basal Meningiomas
Authors: Kumar Pradeep P. , Patil Arun A. , Leibrock Lyal G. , Chu Wei-Kom , Syh Joseph , McCaul Gayle F. , Reeves Michael A. 
Published: April 2011

Abstract
Thirteen patients with intracranial meningiomas of the skull base were treated with one or more high-activity iodine-125 seeds. In 11 patients, the seeds were implanted stereotactically under local anesthesia. A minimum dose of 100 to 500 Gy was delivered to the tumor at a dose rate of 5 to 25 cGy/h. Indications for this procedure included recurrence after initial surgery or as the primary modality of treatment in patients who were not candidates for surgery. All 13 patients are alive at a median follow-up of 15 months. Nine of 11 patients (82%) without calcification in their meningiomas achieved complete response. The remaining 4 patients-2 with calcification and 2 without-achieved partial response. No early or late complications were observed. We conclude from our experience that both recurrent and primary meningiomas of the skull base can be treated effectively with permanent iodine-125 brachytherapy.
Continuous Monitoring of Cerebral Oxygenation in Acute Brain Injury: Assessment of Cerebral Hemodynamic Reserve
Authors: Cruz Julio , Miner Michael E. , Allen Steven J. , Alves Wayne M. , Gennarelli Thomas A. 
Published: April 2011

Abstract
A new index of cerebral hemodynamics, cerebral hemodynamic reserve (CHR), was evaluated in 12 comatose adults with severe, acute, traumatic, diffuse swelling of the brain, who underwent continuous monitoring with a fiberoptic catheter of the saturation difference in arteriojugular oxyhemoglobin. CHR was assessed as the ratio of changes in global cerebral oxygen extraction to changes in cerebral perfusion pressure (CPP) as a result of spontaneous increases in intracranial pressure (ICP). During the course of hyperventilation (Pco2 in the range of 20 mm Hg) for ICP control below 20 mm Hg. 34 observations were made over the initial 48 hours postinjury. Despite normal CPP. in 25 of the observations (73.5%). ICP elevations to the range of 20 mm Hg were associated with compromised CHR. as evidenced by decreases in jugular oxygenation directly attributed to the ICP increases. In the remaining nine observations (26.5%). CHR was preserved, as evidenced by no changes or increases in jugular oxygenation when ICP increased. The CHR improved on the second day. suggesting an improved tolerance of the cerebral hemodynamics to ICP increases. Before the ICP elevations, in most of the observations, the global cerebral blood flow was estimated as being optimally decreased (by hypocapnia). in relation to cerebral oxygen consumption. This was reflected by the occurrence of baseline normalized cerebral oxygen extraction. It is concluded that in this group of patients, under circumstances of profound hyperventilation. ICP elevations within the normal CPP range may result in decreased cerebral oxygenation, even when the normal CPP would imply otherwise. It is suggested that CHR assessment may provide information regarding the status of intracranial “tightness.” insofar as cerebral circulation and oxygenation are concerned.
Spinal Cord Compression Complicating Subarachnoid Infusion of Morphine: Case Report and Laboratory Experience
Authors: North Richard B. , Cutchis Protagoras N. , Epstein Jonathan A. , Long Donlin M. 
Published: April 2011

Abstract
The intraspinal administration of morphine has been employed increasingly in the management of intractable pain of malignant as well as benign origin. We have encountered a previously unreported clinical complication: spinal cord compression by an inflammatory tissue mass surrounding a subarachnoid infusion catheter administering morphine. leading to paraplegia. The patient was referred to our institution after catheter and pump implantation for chronic, intractable pain associated with pre-existing lumbar arachnoid fibrosis, after multiple myelograms and surgeries. The patient may. therefore, have had an underlying propensity to foreign body reactions. We have encountered a similar phenomenon, however, in a canine laboratory model. The pathological features in both our patient and our laboratory preparation, with inflammatory tissue masses around the tip of the catheter but not around proximal subarachnoid segments, suggest an effect related to infusion. as opposed to infection or the presence of the catheter. We review the pathological features in both settings and the pertinent literature.
Cerebrospinal Fluid Shunting for Hydrocephalus in the Adult: Factors Related to Shunt Revision
Authors: Puca Alfredo , Anile Carmelo , Maira Giulio , Rossi Gianfranco 
Published: April 2011

Abstract
Cerebrospinal fluid shunting procedures are widely employed in the treatment of hydrocephalus and other disturbances of the dynamics of cerebrospinal fluid. In spite of its popularity, this operation frequently requires surgical revision. A retrospective analysis of a series of 356 adults who underwent the insertion of a cerebrospinal fluid shunt between January 1970 and December 1988 was performed. The incidence of revision was analyzed, and an attempt was made to identify possible causal factors. The overall incidence of surgical revisions was 28.65%; the number of revisions in the same patient ranged between one and eight. The most frequent causes of revision were distal malposition, obstruction, and infection. A statistically significant difference (P &lt; 0.05) was found in both the risk of revision in patients who had undergone previous operations and those who had not and in the incidence of revision before and after January 1985. Meticulous surgical technique as well as perioperative antibiotic prophylaxis appear responsible for the latter. The differences in the incidence of revision among patients treated with different types of shunts and valves, though remarkable, is not statistically significant.
Pregnancy in Patients with Cerebrospinal Fluid Shunts: Report of a Series and Review of the Literature
Authors: Wisoff Jeffrey H. , Kratzert Kristen J. , Handwerker Sara M. , Young Bruce K. , Epstein Fred 
Published: April 2011

Abstract
Hydrocephalic women with cerebrospinal fluid shunts are now surviving to reproductive age. Twenty-one pregnancies in 18 patients with shunts, including 11 from the present series and 10 from previous series, were analyzed for neurological, obstetrical, and perinatal outcome. Fourteen women had preexisting shunts, and 4 had the onset of symptomatic hydrocephalus and the placement of shunts during pregnancy. Neurological complications occurred in 13 of 17 (76%) pregnancies in patients with preexisting shunts, including symptoms of increased intracranial pressure (ICP) in 10 of 17 (59%) pregnancies, exacerbation of seizure disorder in 2 of 17 (12%) pregnancies, and severe headaches without increased ICD in 1 patient. In 7 of 11 (66%) of the symptomatic patients, symptoms spontaneously resolved postpartum. Four of 17 (23%) of these pregnancies were associated with shunt obstruction requiring antepartum or postpartum surgery. Four patients had a primary shunt placement, and one had a shunt revision during pregnancy without complications. There were no unusual obstetrical or perinatal complications in the series. The clinical management of pregnant patients with hydrocephalus should include preconception counseling and magnetic resonance imaging, as well as the use of serial antenatal magnetic resonance images, ICP monitoring, or the judicious use of radioisotope studies of shunt patency if signs of increased ICP appear. A cesarean section is recommended for the delivery of the neurologically unstable patient. For asymptomatic mothers, a vaginal delivery with a shortened second stage and prophylactic antibiotics are advised.
A Ventricular Infusion Technique for the Evaluation of Treated and Untreated Hydrocephalus
Authors: Morgan Michael K. , Johnston Ian H. , Spittaler Peter J. 
Published: April 2011

Abstract
Patients considered to have a possible disorder of the circulation of the cerebrospinal fluid (CSF) were prospectively randomized on clinical and computed tomographic grounds into one of four categories: low probability of a disorder of circulation of the CSF (n = 14); high probability of a disorder of the circulation of the CSF (n = 10); low probability of shunt malfunction (n = 10); and high probability of shunt malfunction (n = 9). Patients with possible disorders of the circulation of the CSF who did not meet the entry criteria for each of these categories were excluded from this study. A ventricular catheter connected to a subgaleal Rickham reservoir not in continuity with a shunt system (if this was present) either was inserted into each patient or was in place from previous surgery. Infusion studies were conducted by the infusion of 1 ml/min of normal saline through a 25-gauge needle inserted through the skin into the Rickham reservoir. A separate 25-gage needle was inserted into the Rickham reservoir for continuous recording of intracranial pressure. There were 43 infusion studies that were included in the four categories. Recordings of baseline intracranial pressure for a high probability of a disorder of the circulation of the CSF did not differ significantly from a low probability of a disorder of the circulation of the CSF. Baseline intracranial pressure for a high probability of shunt malfunction was significantly higher than the low probability of a disorder of the circulation of the CSF group and the low probability of shunt malfunction group; there was, however, marked overlap in values between these groups. On the other hand, resistance to infusion was no greater than 12 mm Hg ml-1/min-1for all patients with a low probability of a disorder of the circulation of the CSF and no less than 14 mm Hg ml-1/min-1in both the high probability of a disorder of the circulation of the CSF and the high probability of shunt malfunction. This result was significant. The results indicate that this test, which may be applied in an outpatient setting, could be a practical and useful addition to the current methods of the assessment of the circulation of the CSF.
Plasmacytoma of the Skull: Case Reports
Authors: Du Preez Jacomina H. , Branca Enrico P. 
Published: April 2011

Abstract
Two cases of solitary plasmacytoma of the skull are presented. Both patients underwent surgery, and the tumors were removed completely. The patients did not receive postoperative radiotherapy. After a follow-up period of 18 months, neither patient had a local recurrence, but one developed disseminated systemic myeloma.