bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Age and Reoperation on Survival in the Combined Modality Treatment of Malignant Astrocytoma
Authors: Salcman Michael , Kaplan Richard S. , Ducker Thomas B. , Abdo Hatem , Montgomery Elizabeth 
Published: May 2010

Abstract
Before the advent of the operating microscope and the carbon dioxide laser, reoperations were performed in less than 5% of patients with malignant astrocytoma. Between 1978 and 1981, a consecutive series of 74 adult patients were prospectively treated with operation, radiation, and 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) chemotherapy. After the failure of primary therapy, all patients eligible for further treatment were offered reoperation with the microscope and/or laser before treatment with Phase I agents (microwave hyperthermia, dimethyl sulfoxide (DMSO)-Adriamycin, DMSO-Cytoxan, or azaridinylbenzoquinone (AZQ)). Forty-six per cent of the patients were referred from outside institutions for intensive treatment. In 36 months, 40 patients received second operations directed at their tumor and had a median calculated survival from the time of reoperation of 37 weeks. The length of survival after the second operation was independent of patient age, performance status, tumor grade, and interoperative interval. Sixty-five per cent of patients under 40 and 48% of patients over 40 underwent reoperation with minimal morbidity and no deaths. The single most important prognostic factor for survival in both reoperated and single-operated patients was age. Tumor grade had no influence on survival in the series as a whole, in patients under 40 years of age, or in reoperated patients. The calculated median survival for the entire series was 15 months, with a predicted 2-year survival rate of 0.25. These figures include all patients treated without exclusion for incomplete radiotherapy or chemotherapy. It is concluded that reoperation for malignant astrocytoma is safe, feasible, and of potential benefit in combination with other therapies. The routine use of reoperation to “set up” other treatment modalities deserves further study.
Use of the Carbon Dioxide Laser in the Operative Management of Intracranial Meningiomas
Authors: Strait Timothy A. , Robertson Jon H. , Clark Craig W. 
Published: May 2010

Abstract
This study presents 20 cases of meningioma of various intracranial locations, all of which were removed with the carbon dioxide surgical laser system. The carbon dioxide laser is contrasted with other means of meningioma removal to emphasize the advantages of this new technology. These advantages include: (Neurosurgery) the ability to operate with smaller exposures, (Neurosurgery) reduced brain retraction, (Neurosurgery) a reduced amount of mechanical manipulation by vaporizing the tumor mass, (Neurosurgery) vaporization of the dural attachment after the removal of tumor, (Neurosurgery) improved operative precision, and (Neurosurgery) decreased intraoperative blood loss. The authors think that this new technology in combination with the operating microscope represents a significant advancement in the ability to remove meningiomas that might prove difficult to extirpate by conventional means.
Lumbar Monoradiculopathy Due to Unilateral Facet Hypertrophy
Authors: Reynolds Arden F. , Weinstein Philip R. , Wachter Richard D. 
Published: May 2010

Abstract
Twenty-two patients presented during the last 3 years with unilateral symptoms and signs of a lumbar monoradiculopathy indistinguishable from those of a disc herniation. All had compression of the nerve root posteriorly by a hypertrophic facet without anterior compression from the disc. None of the patients had spinal claudication. Preoperative evaluation with computed tomographic (CT) scanning was disappointing as the pathology was correctly defined in only 1 of 10 patients. Lumbar myelography was helpful, but did not always localize the lesion. The decision to operate was based primarily on the clinical grounds of persistent or progressive radiculopathy. The operative techniques used were two-level hemilaminectomy in 7 patients, single level laminectomy in 4, and multilevel laminectomy in 11. Surgical exploration revealed that the site of compression ranged from the medical canal to the lateral recess. The root was compressed by inferior facets 8 times and by superior facets 14 times. Back pain was relieved in 12 of 15 patients, and leg pain was relieved in 19 of 21. Neurological deficit was relieved in 19 and improved in 3. It is concluded that standard CT and myelographic techniques may not anatomically define the point of radicular compression. Intraoperatively the root must be explored from its dural origin to a point beyond the pedicle to ensure adequate decompression. Most, but not all patients with hypertrophic radicular compression will improve after surgical decompression.
Delayed Epidural Hematoma Demonstrated by Computed Tomography
Authors: Rappaport Z. Harry , Shaked Itzchak , Tadmor Rina 
Published: May 2010

Abstract
A case of delayed visualization of an acute parietal epidural hematoma by computed tomography (CT) in a child is presented. The initial CT 2½ hours after injury was negative. After neurological deterioration, a repeat CT scan 8 hours postinjury demonstrated a parietal epidural hematoma and a small cerebellar hematoma. The case demonstrates the need for a high level of vigilance in head trauma patients even in the face of an initially negative CT scan.
Oculomotor Nerve Anastomosis
Authors: Iwabuchi Takashi , Suzuki Mikio , Nakaoka Tsutomu , Suzuki Shigeharu 
Published: May 2010

Abstract
We report a patient who underwent anastomosis of the left oculomotor nerve, which had been inadvertently and bluntly severed during the resection of a left parasellar chromophobe pituitary adenoma. Neural regeneration was confirmed by the reappearance of voluntary adduction of the eyeball, clinical signs of aberrant regeneration, and the appearance of an action potential on electromyography of the levator palpebrae superioris muscle 1 year after end-to-end anastomosis of the nerve.
Acute Cerebrospinal Fluid Hydrothorax
Authors: Davidson R. I. , Zito J. 
Published: May 2010

Abstract
A 3½-year-old child with a bilateral chronic subdural hematoma due to battering suffered a recurrence on one side. She was treated successfully with a subdural-pleural shunt. Two months later, she returned with severe respiratory embarrassment due to what we think was a cerebrospinal fluid hydrothorax. The maintenance of her earlier neurological recovery was confirmed, and her hydrothorax was cured by removing the shunt. No hydrocephalus ensued.
Ischemic Complications after Combined Internal Carotid Artery Occlusion and Extracranial-Intracranial Anastomosis
Authors: Diaz Fernando G. , Ausman James I. , Pearce Jeffrey E. 
Published: May 2010

Abstract
Seven of 120 aneurysm patients admitted to the Henry Ford Hospital from October 1978 to August 1981 had giant internal carotid artery aneurysms that were treated by a combined internal carotid artery occlusion and extracranial-intracranial anastomosis. Three of these patients developed postoperative ischemic complications during the progressive closure of the carotid artery. These complications included the transient onset of syncope, hemiparesis, hemisensory deficits, and dysphasia. These complications resolved after the clamp was reopened and/or intravenous heparin was given. The possible mechanisms involved in the development of ischemia included the development of emboli at the occlusion site or inadequate flow originating from the area of the anastomosis. Prolonged occlusion of the vessel over a 7- to 10-day course with concurrent administration of intravenous heparin is recommended.
Impaired Immunocompetence in Patients with Malignant Gliomas
Authors: Gerosa Massimo A. , Olivi Alessandro , Rosenblum Mark L. , Semenzato Gian Piero , Pezzutto Antonio 
Published: May 2010

Abstract
T-lymphocyte subpopulations (Tg or “suppressor cells” and Tm or “helper cells”) in the peripheral blood of 16 patients with malignant intracranial gliomas were analyzed. The number of Tm-lymphocytes was very close to normal in both preand postoperative samples, whereas Tg-lymphocytes were significantly increased preoperatively (18.55 ± 1.11 vs. 12.72 ± 1.19, p &lt; 0.001) and were still slightly higher than normal after operation and radiation treatment. These preliminary findings suggest a possible role of T-suppressor lymphocytes in the impairment of cell-mediated immunocompetence that has been observed repeatedly in patients with malignant gliomas.
Calculation of Stereotactic Coordinates from the Computed Tomographic Scan
Authors: Gildenberg Philip L. , Kaufman Howard H. , Murthy K. S. Krishna 
Published: May 2010

Abstract
A protocol has been developed to use the GE 8800 scanner and its resident programs to calculate stereotactic coordinates. which has made it possible to use any stereotactic apparatus without modifying the apparatus in order to introduce a cannula into any lesion visualized on a computed tomographic (CT) scan to biopsy tumors. drain abscesses. implant radioisotopes. etc. The CT scanning is done in a routine fashion except that a lateral ScoutView. with the planes of each CT slice indicated, is included. Once the CT scan has been completed, resident programs for measuring distances are used to establish a zero point on a reference plane, from which all other coordinates can be defined. The stereotactic procedure is done at a separate time in the operating room, using the coordinates derived from the CT scan. The ScoutView image is compared to the lateral x-ray film taken during the stereotactic procedure to establish the location of the targets. It has been estimated that the accuracy of this system is 3 mm. Abscesses less than 1 cm in diameter deep within the cerebral hemisphere have been accurately aspirated and tumor biopsies have been successfully taken.
Ventricular Catheter in the Cistern of the Transverse Fissure
Authors: Masdeu Joseph C. , Chuman Charles M. 
Published: May 2010

Abstract
We report a case of shunt malfunction despite a working flushing device and free cerebrospinal fluid flow from the ventricular catheter. The ventricular end of the catheter had been placed in the cistern of the transverse fissure.
Rupture of a Previously Unruptured Giant Middle Cerebral Artery Aneurysm after Extracranial-Intracranial Bypass Surgery
Authors: Scott R. Michael , Liu Hsiu-Chih , Yuan Robert , Adelman Lester 
Published: May 2010

Abstract
The fatal rupture of a previously unruptured giant middle cerebral artery aneurysm occurred 13 days after an extracranial-intracranial bypass had been carried out, before definitive aneurysm surgery. Alterations in blood flow adjacent to the aneurysm after the bypass may have led to the fatal hemorrhage. After a preliminary extracranial-intracranial bypass procedure, there should be no undue delay in the direct attack on a giant aneurysm, regardless of its mode of presentation.
Hypoglossal Neurilemoma
Authors: Berger Mitchel S. , Edwards Michael S. B. , Bingham W. George 
Published: May 2010

Abstract
The case of a patient harboring a rare intracranial hypoglossal nerve sheath tumor is presented, and the literature concerning this lesion, especially with relation to age and sex patterns and the initial and presenting symptoms and signs, is reviewed. The importance of a thorough radiological examination with detailed vertebral angiography and contrast-enhanced computed tomographic scans of the hypoglossal canal is discussed. Based on our experience with this patient, we recommend total excision of this lesion.
Spinal Subdural Metastatic Adenocarcinoma
Authors: Hirsh Leonard F. , Thanki Ashok S. , Spector Harvey B. 
Published: May 2010

Abstract
Metastatic spinal cancer is common and usually involves the bony spine or the epidural space. We are reporting a case of breast carcinoma metastatic to the spinal subdural space, and we review the literature concerning this unusual metastatic site. Unlikely metastatic locations should be suspected whenever myelography in cancer patients with spinal cord signs is confusing.
Ruptured Anterior Spinal Artery Aneurysm
Authors: Moore Daniel W. , Hunt William E. , Zimmerman Eric J. 
Published: May 2010

Abstract
A case of aneurysm at the junction of the vertebrospinal and anterior spinal arteries at the level of C-1 is presented. There was severe intracranial subarachnoid hemorrhage with subsequent right hemiplegia and 6th nerve palsies. Angiograms showed an anomalous arrangement of the arteries, but no arteriovenous malformation was seen. The lesion was repaired via a posterior approach. Anatomical and technical considerations of this approach are discussed. A review of the pertinent literature is presented.
Simple Decompression and Occasional Microsurgical Epineurolysis under Local Anesthesia as Treatment for Ulnar Neuropathy at the Elbow
Authors: Lavyne Michael H. , Bell William O. 
Published: May 2010

Abstract
Decompression of the ulnar nerve in the cubital tunnel will reverse ulnar neuropathy at the elbow in most patients. We believe that operating under local anesthesia has allowed us to identify those few patients who will not respond to simple decompressive surgery. Among the 20 cases of ulnar neuropathy managed in this fashion, intraoperative motor-sensory improvement occurred after simple decompressive surgery in 16. Four patients who failed to improve after cubital tunnel decompression underwent microsurgical epineurolysis immediately thereafter, under the same local anesthetic, with prompt improvement. Local anesthesia and microsurgical epineurolysis seem to be useful adjuncts to simple decompressive surgery for ulnar neuropathy.
Symptomatic Large Parietal Foramina
Authors: Pang Dachling , Lin Angela 
Published: May 2010

Abstract
A mother and her two children with large parietal foramina were studied with plain roentgenograms and computed tomography. The mother's comments convinced us that the bilateral defects in the children evolved from a single midline opening via median ossification. The children had recurrent bouts of unexplained headaches and vomiting. Gentle pressure over the defects and combing of the overlying hair produced local pain and violent headaches in all three patients. These characteristic symptoms as well as other clinical problems associated with this anomaly are discussed.
Neurofibroma of the Infratemporal Fossa: Case Report and Technical Note
Authors: Rengachary Setti S. , McMahon Michael , Bigongiari Lawrence R. , Ketcherside Joseph , Gunter Kurt 
Published: May 2010

Abstract
The authors present a case of benign neurofibroma arising from the infratemporal fossa, which they removed successfully through a transoral transmaxillary approach. The anatomy of the infratemporal region is discussed. The transoral transmaxillary approach and the parotid approach to the infratemporal fossa are contrasted.
Supratentorial Subarachnoid Epithelial Cyst: Case Report and Ultrastructural Study
Authors: Pearl Gary S. , Takei Yoshio , Tindall George T. , Hoffman James C. 
Published: May 2010

Abstract
Supratentorial epithelial cysts are rare entities that have evoked controversy regarding their pathogenesis. Recent ultrastructural studies have failed to resolve this controversy. We present a case report and an ultrastructural study of such a cyst. The cyst wall was lined by columnar epithelial cells with prominent cilia and microvilli at their apical surface. They were joined by well-developed junctional complexes and contained abundant intracytoplasmic, electron-dense, granular material. some of which was membrane-bound. These ultrastructural findings suggest that epithelial cysts are derived from elements of the embryological tela choroidea.
Hemianopia: A Presenting Feature of Acute Epidural Hematomas
Authors: Matwijecky Cornelius , Steinbok Paul 
Published: May 2010

Abstract
Visual field abnormalities were studied in a retrospective analysis of 199 patients with epidural hematomas. One hundred three patients had been alert enough at the time of hospital admission to have had their visual fields examined, but in only 27 patients were visual fields documented in the charts. Six of the 27 patients (22%) had a correctly localizing homonymous hemianopia. The case histories of these 6 patients are detailed and the pathogenetic mechanisms of the visual field abnormalities are discussed. The importance of recognizing that homonymous hemianopia can be an early sign of an epidural hematoma is stressed.
Mega Cisterna Magna: Diagnosis Using Metrizamide Computed Tomographic Cisternography
Authors: Hough Douglas R. , Mengel Mark B. , Malik Ayaz H. 
Published: May 2010

Abstract
The mega cisterna magna is one cause of a midline, extra-axial, posterior fossa cyst. The computed tomographic features and differential diagnosis of midline posterior fossa cystic structures are reviewed, and the clinical features of the mega cisterna magna are discussed. We describe a method of metrizamide cisternography and report a case of mega cisterna magna that was diagnosed by this technique.
Tension Pneumocephalus after Surgical Treatment of Chronic Subdural Hematoma: Report of Three Cases
Authors: Bremer Alfonso M. , Nguyen Tai Q. 
Published: May 2010

Abstract
This report illustrates three cases of symptomatic tension pneumocephalus developing after evacuation of chronic subdural hematoma (SDH) by burr holes. Review of the literature revealed that tension pneumocephalus is seldom recognized as a reason for neurological deterioration after the surgical treatment of chronic SDH.
Hemodynamic Effects of N2O, O2 Barbiturate Anesthesia and Induced Hypotension in Early versus Late Aneurysm Clipping
Authors: Sokoll M. D. , Kassell N. F. , Gergis S. D. 
Published: May 2010

Abstract
The cardiovascular effects of large dose thiopental anesthesia and induced hypotension were examined in 22 patients undergoing clipping of ruptured intracranial aneurysms. Eleven patients operated on within 4 days of the initial bleed (early group) were compared with those operated on more than 10 days after the bleed (late group). Systemic and pulmonary arterial pressures, central venous pressure, and cardiac output were measured. The cardiac index and the systemic and pulmonary vascular resistance were calculated. Before the induction of anesthesia, the cardiac index was 4.00 ± 0.3 litres/minute/m2 in the early group compared with 2.89 ± 0.23 litres/minute/m2 in the late group (P &lt; 0.05). Five and 10 minutes after the administration of mannitol (1 g/kg) and at an induced hypotensive level of 60 torr, the cardiac index remained significantly higher in the early group (P &lt; 0.05). There was no significant difference in the mean arterial blood pressure between the groups. Systemic vascular resistance was significantly higher in the late group during the postinduction and the pre-mannitol infusion periods and at induced hypotensive levels of 50 and 40 torr. Central venous pressure was significantly higher in the early group only at the preanesthesia (control) measurement. There was no significant difference between the groups in the pulmonary artery wedge pressure or the pulmonary vascular resistance.
Subarachnoid Enhancement Secondary to Subarachnoid Hemorrhage with Special Reference to the Clinical Significance and Pathogenesis
Authors: Hirata Yoshifumi , Matsukado Yasuhiko , Fukumura Akinobu 
Published: May 2010

Abstract
Contrast-enhanced computed tomographic scans of 30 patients with acute subarachnoid hemorrhage due to ruptured intracranial aneurysm were analyzed in relation to subarachnoid enhancement and clinical features. In 15 cases, subarachnoid enhancement was noted either early or late during the clinical progress of subarachnoid hemorrhage. In the positive group, hydrocephalus and cerebral infarction due to vasospasm frequently accompanied enhancement during the early stage of subarachnoid hemorrhage. The diffuse type of subarachnoid enhancement was most valuable for predicting cerebral infarction due to vasospasm. The authors review the literature on the pathogenesis of subarachnoid enhancement.
Clinical Toxicity of Combined Modality Treatment with Nitrosourea Derivatives for Central Nervous System Tumors
Authors: della Cuna Gioacchino Robustelli , Paoletti Pietro , Bernardo Giovanni , Knerich Roberto , Butti Giorgio , Cuzzoni Quinto 
Published: May 2010

Abstract
Two nitrosourea compounds— 1,3-bis(2-chloroethy1)-1-nitrosourea (BCNU) and 1-(2-chloroethy1)-3-cyclohexyl-1-nitro-sourea (CCNU)—have been used in the treatment of primary and metastatic brain tumors after operation and/or radiotherapy. Hematological and nonhematological toxicity were recorded in 272 patients treated between May 1973 and June 1978. BCNU was given to 135 patients (80 mg/m2 i.v. daily for 3 days) and CCNU was given to 137 patients (130 mg/m2 orally, single dose) every 8 weeks until progression of the primary disease process or for a total of 12 cycles. Radiation therapy (5500 ± 500 rads in 6 to 7 weeks) was carried out after the first course of chemotherapy. BCNU and CCNU induced the same hematological and clinical toxicity. The bone marrow toxicity seemed to be dose-related, delayed, and cumulative. One case of acute nonlymphoblastic leukemia arising 2 months after the end of CCNU therapy is reported.
Early Management of Aneurysmal Subarachnoid Hemorrhage
Authors: Ljunggren Bengt , Brandt Lennart , Sundbärg Göran , Säveland Hans , Cronqvist Sten , Stridbeck Hans 
Published: May 2010

Abstract
The Lund Clinic serves a population of 1.46 million inhabitants. During the calendar year 1981, 72 patients presented with a ruptured supratentorial aneurysm, diagnosed either at angiography or at autopsy. Upon admission, 60% of the patients were in good condition and 40% were in poor condition. Eighty-three per cent were admitted within 72 hours after the subarachnoid hemorrhage (SAH). In the total series, 50% made a good recovery; the overall management morbidity was 19%, and the management mortality was 31%. Thirty-one patients in Grades I–III underwent early operation (43% of the total series), with a favorable outcome in 74% and 7% mortality. Of the 35 patients who were admitted early and in good condition, 71% made a good recovery, and the management mortality was 9%. These figures may be compared to the 51% favorable outcome and 27% mortality reported from the Cooperative Aneurysm Study with late operation. In the early operation cases, the incidence of significant arterial narrowing at postoperative angiography performed on Day 9 ± 2 after SAH was 30% and the incidence of permanent neurological deficits of delayed onset was 10%. Two of the early operation patients developed permanent symptomatic hydrocephalus.
Penetrating Spinal Injury by a Glass Fragment: Case Report and Review
Authors: Baghai Parviz , Sheptak Peter E. 
Published: May 2010

Abstract
Stab wounds of the spinal canal are rare. Usually they produce obvious neurological deficits, but occasionally patients present with cerebrospinal fluid leak or related symptoms. We report a case of penetration of the lumbar dural sac with a glass fragment. Postural headache and mild back pain were the only presenting complaints. The radiological findings, surgical indications, and management are discussed, and a review of the literature is presented.
Evolving Role of Digital Subtraction Angiography in Neurosurgical Practice
Authors: Duff Thomas A. , Turski Patrick A. , Sackett Joseph F. , Strother Charles M. , Crummy Andrew B. 
Published: May 2010

Abstract
Advances in digital subtraction angiography (DSA) have allowed the evaluation of a number of pathological conditions involving the extra-and intracranial vasculature. In addition to its role in diagnosis. DSA has been used for the postoperative assessment of endarterectomy, aneurysm clipping, and vascular bypass and for the follow-up of arteriovenous fistulas or malformations. This paper describes the theory and anticipated improvements in the digital processing of radiological information and presents our initial assessment of its clinical utility.