bluuebunny/crossref_metadata_2025_split huggingface dataset:
Computed Tomographic Diagnosis of Ruptured Giant Posterior Cerebral Artery Aneurysms
Authors: Scott LCDR Brett A. , Weinstein Zelig , Pulliam CDR Morris W. 
Published: May 2010

Abstract
Ruptured giant posterior cerebral artery (PCA) aneurysms are encountered rarely. Although computed tomographic (CT) scan features of giant intracranial aneurysms have been described. CT scan features of acutely ruptured giant saccular PCA aneurysms have not been reported. A case of an acutely ruptured giant saccular PCA aneurysm with diagnostic CT scan features and autopsy confirmation is presented. Two additional cases of apoplexy with identical clinical courses and CT scan appearances, both attributed to giant saccular PCA aneurysms, are described. Diagnostic CT scan features included evidence of intraparenchymal temporal lobe and intraventricular hemorrhage, the presence of a filling defect in the temporal lobe hematoma that enhanced after intravenous contrast administration, and evidence of proximal PCA entrance into the contrast-enhanced filling defect in the intracerebral hematoma. The incidence of PCA aneurysms and the anatomy of the PCA as it relates to these giant aneurysms, their clinical presentation, and diagnostic features of the CT scan are discussed. (Neurosurgery 22:553-558, 1988)
Effective Preoperative Irradiation of Highly Vascular Cerebellopontine Angle Neurinomas
Authors: Ikeda Kiyonobu , Ito Haruhide , Kashihara Kengo , Fujisawa Hirosuke , Yamamoto Shinjoro 
Published: May 2010

Abstract
Three cases of large cerebellopontine angle neurinoma with marked vascularity and tumor staining on the angiogram were treated with effective preoperative irradiation. The radiotherapy was given before the second operation in two cases and before the first operation in the other case. Irradiation doses administered with a linear accelerator were 2.34 to 3.0 Gy for 3 to 3.5 weeks, and radical operations were done 1.5 to 2 months after irradiation. After the irradiation, vertebral angiography showed moderate to marked decrease of the hypervascular capsular stain and disappearance of the early draining vein. Computed tomographic scan showed enlargement of the central necrotic area within the heterogeneously enhanced tumor, which was unchanged in size. Radical operations, which had been impossible because of uncontrollable massive bleeding, were successful without any intraoperative bleeding after radiotherapy. Postirradiation radiological findings corresponded well with those of histopathological examination, which showed decrease in cellularity and in vascularity and diffuse coagulation necrosis around the collapsed tumoral vessels as radiation effects. Preoperative irradiation of the hypervascular neurinoma was thought to facilitate radical surgery by abolishing or diminishing the risk of intraoperative bleeding. (Neurosurgery 22:566-573, 1988)
Computed Tomography and Magnetic Resonance Imaging in Traumatic Locked-In Syndrome
Authors: Zampella Edward J. , Duvall Ernest R. , Langford Keith H. 
Published: May 2010

Abstract
The first reported case of traumatic locked-in syndrome with computed tomographic and magnetic resonance scan confirmation of the brain stem lesion is presented. The lesion responsible for the patient's condition consisted of a hemorrhage in the ventral pontomedullary junction. The pathophysiology of the production of such lesions is discussed. (Neurosurgery 22:591-593, 1988)
Thrombosis of a Giant Aneurysm of the Basilar Artery
Authors: Marchau M.M.B. , Vallaeys J. , Vanhoonen G. 
Published: May 2010

Abstract
Thrombosis of a giant aneurysm of the basilar artery appears on computed tomographic scan as a well-delineated, prepontine, hyperdense mass. (Neurosurgery 22:612-613, 1988)
Surgical Management of Extreme Lateral Lumbar Disc Herniations: Review of 138 Cases
Authors: Abdullah Adel F. , Wolber Paul G. H. , Warfield John R. , Gunadi I. Krist 
Published: May 2010

Abstract
Extreme lateral disc herniations in the authors' series account for 10% of all lumbar herniations; 80% occurred at the L3, L4 and L4, L5 interspaces. The authors review the clinical findings in 138 patients and point to the characteristic features of the clinical syndrome. They compare the accuracy of various diagnostic studies and conclude that computed tomography is highly accurate and should be used before other diagnostic studies. Discography is still helpful as a confirmatory study in some cases, whereas myelography is particularly useful in disclosing other associated lesions. Analysis of the operative series revealed a high percentage of extruded fragments (60%) and a significant number of double herniations on the same side and at the same level (15%). These two findings may respectively preclude chemonucleolysis and microsurgery from the surgical management of extreme lateral herniations. Double herniations explain some discrepancies in the clinical picture and are emphasized as a potential source of error in diagnosis. The surgical technique allows exploration for herniations within the intervertebral canal as well as for extraforaminal herniations without sacrifice of the facet. Operative results are presented.
Feasibility and Efficacy of Preirradiation Chemotherapy for Pediatric Brain Tumors
Authors: Horowitz Marc E. , Kun Larry E. , Mulhern Raymond K. , Kovnar Edward H. , Sanford Robert A. , Hockenberger Beverly M. , Greeson Frances L. , Langston James W. , Fairclough Diane L. , Jenkins Jesse J. 
Published: May 2010

Abstract
Preirradiation chemotherapy is a potentially important component of combined treatment for brain tumors; however, concerns over its side effects and antitumor activity have impeded its evaluation in clinical trials. To determine the feasibility of administering such therapy to children, we assessed the responses of 38 brain tumor patients (median age, 2 years) to 12 weeks of combination chemotherapy given after surgical resection but before irradiation. Transient myelosuppression was noted in all patients, but was not associated with infections or complications of surgical wounds. The ability of the patients to perform activities of daily life, as rated with the Karnofsky performance scale, was either improved (n = 14) or unchanged (n = 18) at the end of the evaluation period. In the remainder of the group, functional deterioration was clearly related to causes other than drug treatment. Prior chemotherapy did not compromise the delivery of radiation except for a brief interruption of spinal irradiation in 3 patients. Objective responses to chemotherapy, defined as a &gt;50% decrease in tumor masses, occurred in 16 of the 31 patients who had subtotal resections; only 6 patients in the entire group showed disease progression during the 12 weeks of drug administration. We conclude that chemotherapy of the type used in this study is well tolerated and produces beneficial effects in children with brain tumors.
Treatment of Recurrent Brain Stem Gliomas and Other Central Nervous System Tumors with 5-Fluorouracil, CCNU, Hydroxyurea, and 6-Mercaptopurine
Authors: Rodriguez Luis A. , Prados Michael , Fulton Dorcas , Edwards Michael S. B. , Silver Pamela , Levin Victor 
Published: May 2010

Abstract
Twenty-one patients with recurrent malignant central nervous system gliomas were treated with a combination of 5-fluorouracil, CCNU, hydroxyurea, and 6-mercaptopurine. Thirteen patients had brain stem gliomas, 3 patients had spinal cord gliomas, 3 patients had thalamic gliomas, and 2 patients had cerebellar astrocytomas. All patients had received radiation therapy, and 4 brain stem patients had also been treated with chemotherapy. Sixteen patients (76%) responded to treatment with either stabilization of disease or improvement. Nine of the 13 patients with brain stem gliomas (71%) had response or stabilization of disease. The median time to tumor progression (TTP) for the brain stem patients who responded or had stabilization of disease was 25 weeks. The median survival from recurrence for the brain stem glioma patients was 27 weeks. Patients with cerebellar, thalamic, and spinal cord tumors did very well, with an 87% response or stabilization of disease and a median TTP of 122 weeks.
Intradural Herniated Dorsal Disc: Case Report and Review of the Literature
Authors: Isla Alberto , Roda José M. , Bencosme José , Alvarez Marcelino P. , Blázquez Martín G. 
Published: May 2010

Abstract
A 67-year-old man with a 1 1/2;-month history of spastic paraparesis caused by a dorsal intradural disc herniation underwent surgical treatment via a posterior approach. Dorsal herniated discs are rare, and intradural dorsal disc herniations are even more infrequent. Including this case, the medical literature reviewed describes only four such cases.
Origin of Organisms Infecting Ventricular Shunts
Authors: Shapiro Scott , Boaz Joel , Kleiman Martin , Kalsbeck John , Mealey John 
Published: May 2010

Abstract
Results of skin cultures obtained before 413 of 505 operations for cerebrospinal fluid-diverting ventricular shunt placement or revision in a pediatric population from April 1980 to May 1983 are analyzed and compared to results of cultures from 20 subsequent shunt infections. Sensitivities to 11 different antibiotics were determined for each isolate cultured. The total operative infection rate was 20 of 505 (4%). Gram-negative bacilli alone accounted for 3 of 20 (15%) shunt infections. One gram-negative bacillus/Staphylococcus aureus infection occurred. Factors predisposing for gramnegative bacillus shunt infection were found in all 4 cases. The majority of shunt infections were caused by typical resident skin organisms: Staphylococcus epidermidis alone, 9/20 (45%); Staphylococcus aureus alone, 4/20 (20%); Corynebacterium sp., 1/20 (5%); α-Streptococcus with S. epidermidis, 1/20 (5%); and Micrococcus with S. epidermidis, 1/20 (5%). Only 4 (20%) of the 20 shunt infections were due to organisms identical to those originally grown from the skin. Another 4 (20%) seemed to be infected with a strain of organism different from that initially recovered from the skin. The remaining skin organism shunt infections may or may not have come from the patient's skin. The data suggest that not all skin organism shunt infections arise from contamination by resident skin bacteria at the incision sites at the time of operation. Alternate sources for the infecting organisms are discussed. The antibiotic sensitivity data on skin isolates and shunt isolates suggest that vancomycin is the antibiotic best suited for prophylaxis against shunt infection at our institution.
Adipose Tissue in the Filum Terminale: A Computed Tomographic Finding That May Indicate Tethering of the Spinal Cord
Authors: McLendon Roger E. , Oakes Jerry W. , Heinz Ralph E. , Yeates Andrew E. , Burger Peter C. 
Published: May 2010

Abstract
Adipose tissue in the filum terminale is frequently associated with tethering of the spinal cord in patients with spina bifida occulta (3, 8). We recently saw a patient with low back pain and no spina bifida occulta, in whom adipose tissue was noted in the area of the filum on an unenhanced computed tomographic (CT) scan. The patient had a tethered cord. This case suggested that, when CT scanning is done as the first imaging study in the evaluation of low back pain, fatty tissue in the area of the filum may be an indicator for tethering of the spinal cord. The present study was undertaken to determine the validity of using CT scan-detectable filal fat in the identification of possible tethered spinal cords among a group of patients experiencing low back pain. The presence of fat in the fila of 12 patients with the radiologically and histologically tethered cord syndrome was evaluated and the fila of 47 autopsied patients whose clinical history showed no back pain were examined histologically. There were accumulations of adipose tissue in the fila of 11 of the 12 (91%) patients with the tethered cord syndrome and in the fila of 9 of the 47 patients (17%) in the autopsy series. Of the 9 autopsy patients with fat in their fila, however only 3 patients (6%) exhibited collections of adipose tissue in the CT detection range (2 mm). These results demonstrate that, although CT scan-detectable adipose tissue can be found in the filum of an occasional patient without tethered cord, CT detectable fat in the filum of a patient with low back pain should prompt an evaluation for a tethered spinal cord. CT scanning has potential as a noninvasive tool in such a work-up.
Bilateral Chronic Subdural Hematomas without Communication between the Hematoma Cavities: Treatment with Unilateral Subdural-Peritoneal Shunt
Authors: Aoki Nobuhiko , Masuzawa Hideaki 
Published: May 2010

Abstract
Communication between bilateral subdural hematoma cavities was not demonstrated by metrizamide computed tomography subdurography in three patients with bilateral chronic subdural hematomas. Because unilateral subdural tapping yielded a slack fontanel without untoward neurological findings, patients were treated by the placement of unilateral subdural-peritoneal shunts, resulting in resolution of the bilateral hematomas.
Cerebral Malignant Tumors with Ependymal and Choroidal Differentiation in Two Siblings
Authors: Munoz David G. , Griebel Robert , Rozdilsky Bohdan , George David 
Published: May 2010

Abstract
Two siblings in a family without a history of phacomatosis or cerebral tumors developed malignant tumors in the posterior fossa at age 28 months and in the left cerebral hemisphere at age 15 months, respectively. Dual ependymal and choroid plexus epithelium differentiation was established by histological, ultrastructural, and immunocytochemical studies. The development of this rare tumor in siblings suggests an inherited predisposition, a common environmental insult, or both.
Myelopathy after the Intrathecal Administration of Hypertonic Saline
Authors: Kim R. C. , Porter R. W. , Choi B. H. , Kim S. W. 
Published: May 2010

Abstract
The neuropathological effects of intrathecally administered hypertonic saline have not been described previously. We report a patient who, within a day of receiving 20 ml of hypertonic (7.5%) saline intrathecally, developed flaccid paraplegia and complete sensory loss below the umbilicus. Subsequently, there was some transitory return of motor and coarse sensory function. The patient died 16 months after the injection. At autopsy, there was peripherally accentuated loss of myelinated fibers within the spinal cord from T12 downward, as well as dense collagenous thickening of the dorsal leptomeninges from T9 to T11. The findings in this case, coupled with observations made by others, serve to emphasize the need for extreme caution whenever planning any form of intrathecal therapy.
Anomalies and Variations of the Middle Cerebral Artery : A Micro anatomical Study
Authors: Umansky Felix , Dujovny Manuel , Ausman James I. , Diaz Fernando G. , Mirchandani Haresh G. 
Published: May 2010

Abstract

The microvascular anatomy of the main trunk and divisions of the middle cerebral artery was studied in 104 unfixed brain hemispheres injected with polyester resin and dissected under the operating microscope. The following anomalies and variations of the middle cerebral artery were found: fenestration (1 case; 1%), located on the first 4 mm of the main trunk of the middle cerebral artery; duplication (1 case; 1%). with vessels arising from the internal carotid artery; accessory middle cerebral artery (2 cases; 2%). originating on the A, segment of the anterior cerebral artery; single-trunk type of middle cerebral artery (4 cases; 4%), with no division of its main trunk; quadrifurcation (4 cases; 4%), in which the main trunk of the middle cerebral artery divided into four secondary trunks. The clinical implications of these anatomical findings are discussed, and photographs of representative specimens illustrate the anomalies.
Significant Functional Recovery after Delayed Evacuation of Traumatic Thoracic Intramedullary Hematoma: Case Report
Authors: Andrews Russell J. , Chien C.-C. 
Published: May 2010

Abstract

A patient with traumatic thoracic intramedullary hematoma underwent operation 1 month postinjury. Evacuation and syringosubarachnoid shunting resulted in return of bladder control and of sufficient strength in the lower extremities to permit independent walking. The outcome is discussed in light of the literature on traumatic intramedullary hematoma. The value of magnetic resonance imaging is noted. We suggest an aggressive diagnostic and therapeutic approach toward intramedullary spinal cord hematomas.
Teflon Injection for Vocal Cord Paralys is after Intracranial Operation
Authors: Heller Elliot M. , Ransohoff Joseph , Plasse Harvey , Cohen Noel L. 
Published: May 2010

Abstract

Vocal cord paralysis may follow intracranial operation if the vagus nerve is damaged intraoperatively. If the resulting laryngeal incompetence is severe, hoarseness, dysphagia, and aspiration may develop. This is often followed by a pneumonitis requiring chronic gastric tube feeding. Teflon vocal cord injection has been shown to restore the sphincteric action of the larynx and enable patients to phonate and swallow properly again. Nine patients underwent this procedure for chronic aspiration and hoarseness. All had vagus injury attributable to antecedent intracranial operation, and all experienced relief of their symptoms with only minor complications. Teflon vocal cord injection is advocated as a safe, effective means of managing patients with aspiration and dysphagia secondary to vagus nerve injury.
Differences in Glycoconjugates of Adrenocorticotropic Hormone-secretory Granules between Nonadenomatous Pituitary Cells and Adenoma Cells as Detected by Double Labeling
Authors: Hori Tomokatsu , Nishiyama Fumiaki , Anno Yuichi , Tanaka Satoshi , Watanabe Takashi , Hirano Hiroshi 
Published: May 2010

ABSTRACT
Lectin binding sites of adrenocorticotropic hormone (ACTH) secretory granules of human pituitary adenomas and of nonadenomatous pituitary tissue adjacent to adenomas were studied by postembedding immunocytochemical doublestaining on ultrathin sections followed by electron microscopy. The specific hormones produced by the secretory granules were identified by labeling one side of the section with anti-human pituitary hormone antibodies conjugated to gold particles. Simultaneously, the other side was labeled with horseradish peroxidase-lectin to reveal lectin binding sites. Specimens were obtained from four human ACTH-producing pituitary adenomas and from nonadenomatous pituitary tissue surrounding three other adenomas. The four ACTH-producing adenomas showed either weak or negative reactions with concanavalin A, whereas the nonadenomatous ACTH-producing pituitary cells reacted strongly with concanavalin A. Moreover, ACTH secretory granules were significantly larger in the nonadenomatous cells than in adenoma cells. Differences in biochemical structure and ultrastructure between nonadenomatous (normal) pituitary cells and adenoma cells secreting the same specific hormones were demonstrated, and the clinical implications of the results were discussed.
Posterior Fossa Subdural Effusion Due to Head Trauma
Authors: Nishizaki Tomoyuki , Tamaki Norihiko , Fujiwara Hitoshi , Matsumoto Satoshi 
Published: May 2010

ABSTRACT
We report 3 cases of posterior fossa subdural effusion resulting from head trauma, and we review 20 previously reported cases. All patients with the acute type presented with progressive deterioration of consciousness associated with stiff neck, seizure, and dyspnea (apnea). By contrast, in the subacute or chronic type, persistent headache, multiple cranial nerve pareses, and ataxia were characteristic. Occipital bone fracture was common in the acute type, and supratentorial subdural effusion was more frequently associated with the subacute or chronic type. Evacuation of the subdural fluid collection through a burr hole is the most common and effective treatment, but subdural-peritoneal shunting or closed drainage of the subdural fluid collection may be necessary. The prognosis of posterior fossa subdural effusion after head trauma is relatively good.
Pyriformis Syndrome in a 10-Year-old Boy as a Complication of Operation with the Patient in the Sitting Position
Authors: Brown Jeffrey A. , Braun Michael A. , Namey Thomas C. 
Published: May 2010

ABSTRACT
We present a case of sciatic neuropathy due to the pyriformis syndrome after operation in the sitting position. Neither sciatic nerve injury nor the pyriformis syndrome has been reported after operation in the sitting position, although a low incidence of common peroneal nerve injury has been reported as a complication of operation on patients who are in the sitting position. The clinical findings of sciatic neuropathy, external rotation of the ipsilateral foot in the position of comfort, and a therapeutic response to local anesthetic injection into the pyriformis muscle are diagnostic of the syndrome. Nerve conduction studies should be performed to aid in the differentiation between a common peroneal and sciatic neuropathy. The syndrome may occur because of extreme flexion of the hips and prolonged pressure while in the sitting position, leading to pyriformis muscle trauma, resultant spasm, and sciatic compression. The prognosis is for complete recovery after symptomatic treatment with nonsteroidal antiinflammatory medication and physical therapy.
Functional Recovery after Decompressive Craniectomy for Cerebral Infarction
Authors: Kondziolka Douglas , Fazl Mahmood 
Published: May 2010

ABSTRACT
There is continuing controversy about the benefits of decompressive craniectomy in the treatment of lesions causing increased intracranial pressure (ICP) and brain edema. Laboratory work has shown a decrease in ICP after craniectomy, but also a paradoxical enhancement in the formation of underlying cerebral edema, which may act to the detriment of the patient. Since Rengachary et al. advocated craniectomy for massive cerebral infarction and reported their group of three patients, we have managed five patients with acute supratentorial cerebral infarction who progressed to uncal herniation and impending death from raised ICP and brain stem compression. All were treated with frontotemporal craniectomy after conventional medical therapy failed to achieve a response. All patients survived and are walking, despite a paresis appropriate to their original stroke. Two have returned to work. Good results with supratentorial craniectomy after infarction show that this procedure is life-saving and can also give acceptable functional recovery.
Surgical Approaches to Aneurysms of the Vertebral and Basilar Arteries
Authors: Solomon Robert A. , Stein Bennett M. 
Published: May 2010

ABSTRACT
This report details the surgical treatment of 44 patients with aneurysms of the vertebral and basilar arteries. Three different surgical approaches were utilized depending on the location of the aneurysm. These were an anterior supratentorial approach, a lateral suboccipital approach, and a combined supratentorial and infratentorial approach along the petrous apex, with section of the lateral sinus and the tentorium. Using these operative exposures, aneurysms located anywhere on the vertebral-basilar arteries may be safely visualized and clipped. In this series, 1 patient died, 4 other patients had significant, long-lasting morbidity as a result of operation, and 32 patients returned to work and a normal life-style. These data support operative intervention under proper conditions and with selection of the correct exposures for the treatment of vertebral-basilar aneurysms.
Ruptured Dissecting Aneurysm of the Vertebral Artery Revealed by Repeat Angiography
Authors: Ito Yasushi , Ishii Ryoji , Suzuki Yasuo , Kikuoka Masahisa , Hirano Kazuhiro , Kodama Shuhei 
Published: May 2010

ABSTRACT
A case of subarachnoid hemorrhage caused by the rupture of a dissecting aneurysm of the vertebral artery is reported. The initial angiogram was normal, and repeat angiography carried out 12 days later revealed a dissecting aneurysm of the right vertebral artery. This angiographic change seems to be due to the progression of minimal dissection that was not found at the time of first angiogram.