bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relief of Lumbar Canal Stenosis Using Multilevel Subarticular Fenestrations as an Alternative to Wide Laminectomy: Preliminary Report
Authors: Young Steven , Veerapen Richard , O'Laoire Sean A. 
Published: May 2010

Abstract
We describe an operative approach to lumbar canal stenosis which, unlike laminectomy, takes into account the segmental pathology of the disease. At each level involved, a bilateral subarticular fenestration is performed under high magnification. The medial third of each facet joint is first removed with an air-powered drill; then the remaining two-thirds of the joint is undercut with the drill to allow a generous fenestration in the thickened ligamentum flavum and adjacent laminae. All tissue responsible for neural compression is removed, but the spinous processes, interspinous ligaments, and much of the facet joints and laminae are preserved. Spinal stability is maintained and, because tissue disruption is minimized, postoperative discomfort is usually reduced, promoting early mobility and reduced hospital stay. The operation is described in detail, and the results of operation in 32 patients are assessed. The follow-up periods now range from 17 to 58 months. Of 23 patients who presented with neurogenic claudication, 14 (61%) obtained complete relief and 7 (30%) improved significantly. The mean hospital stay was 9 days (range, 4 to 17 days).
Spontaneous Postoperative Normalization of Growth Hormone Levels in Two Patients with Acromegaly Not Cured by Transsphenoidal Surgery
Authors: Landolt A. M. , Froesch E. R. , König M. P. 
Published: May 2010

Abstract
Postoperative persistence of elevated growth hormone (GH) levels in patients with acromegaly usually suggests residual adenoma tissue secreting GH and is an indication for further treatment. In rare cases, spontaneous normalization of serum GH levels in patients with acromegaly has been reported to occur as a consequence of intratumoral hemorrhage (pituitary apoplexy). We report two patients in whom persisting acromegaly was documented 1 and 2 weeks, respectively, after transsphenoidal operation and who experienced spontaneous normalization of GH levels. In one patient, this favorable outcome was found 1.5 years after the operation and followed a pregnancy. The other patient, whose GH values normalized 3 months after operation, had received preoperative treatment with a new, long-acting somatostatin analog.
Rhinocerebral Mucormycosis with Extension to the Posterior Fossa: Case Report
Authors: Soloniuk Donald S. , Moreland Douglas B. 
Published: May 2010

Abstract
A 25-year-old man with juvenile onset diabetes presented with rhinoorbital mucormycosis. He was treated aggressively with orbital extirpation and amphotericin B. Six months later, he presented with posterior fossa extension of the mucormycosis.
Cerebrospinal Fluid Eosinophilia and Sterile Shunt Malfunction
Authors: Traynelis Vincent C. , Powell Randell G. , Koss William , Schochet Sydney S. , Kaufman Howard H. 
Published: May 2010

Abstract
Cerebrospinal fluid (CSF) eosinophilia is a rare finding most often associated with central nervous system inflammatory processes, including parasitic, bacterial, and mycotic infections. It has also been seen as an allergic phenomenon. We present two cases of CSF eosinophilia occurring concurrently with sterile shunt malfunction. We speculate that CSF eosinophilia in our patients might have resulted from an allergic response to a foreign material such as suture, surgical glove powder, hair, cotton fibers, antibiotics, or silicone rubber. The incidence of sterile CSF eosinophilia after shunting is not known. Information concerning the role of eosinophilia in the development of shunt malfunctions is also lacking. An increased awareness of this possibility and further investigation are warranted.
Carotid-Anterior Cerebral Artery Anastomosis with Aneurysm: Case Report and Review of the Literature
Authors: Odake Genya 
Published: May 2010

Abstract
A ruptured aneurysm at the origin of the bilateral pericallosal arteries with an anomalous anterior cerebral artery was found in a 56-year-old man. The abnormal solitary anterior cerebral artery arose from the intracranial proximal internal carotid artery, passed underneath the ipsilateral optic nerve, and turned upward at the midline as a common trunk of the bilateral pericallosal arteries. Subarachnoid hemorrhage recurred 15 days postoperatively, and the patient did poorly. The 20 published cases of this rare anomaly (an infraoptic course of the anterior cerebral artery with a low bifurcation of the internal carotid artery) are reviewed. This anomaly should be referred to by the descriptive term “carotid-anterior cerebral artery anastomosis.” It is frequently associated with aneurysms.
Combined Treatment of Osteosarcoma of the Spine
Authors: Sundaresan Narayan , Rosen Gerald , Huvos Andrew G. , Krol George 
Published: May 2010

Abstract
We reviewed the clinical features and results of treatment in 24 patients with osteogenic sarcoma of the spine treated over a 35-year period. There were 14 male and 10 female patients 13 to 71 years old. The tumor arose de novo in 13 patients and was secondary to other conditions in 11. All patients presented with pain, and 16 (67%) had neurological deficits. Patients were divided into two treatment groups. Thirteen patients treated from 1949 to 1977 usually underwent limited tumor resection and external radiation therapy. The second group, 11 patients treated from 1978 to 1984, underwent more aggressive surgical resection and received combination chemotherapy as well as local rediation to the tumor bed. In the second group, there were 5 long term survivors, and only 1 patient developed metastatic disease while on therapy. Failure to obtain local control was the major cause of treatment failure. Complete surgical resection of the tumor by spondylectomy and combination chemotherapy offer the best prospect for cure of osteogenic sarcoma of the spine.
Intralesional Infusion of Lymphokine-activated Killer (LAK) Cells and Recombinant Interleukin-2 (rIL-2) for the Treatment of Patients with Malignant Brain Tumor
Authors: Merchant Randall E. , Merchant Lynn H. , Cook Sallie H. S. , McVicar Daniel W. , Young Harold F. 
Published: May 2010

Abstract
Twenty patients with supratentorial, intracerebral lesions defined by computed tomographic scan or magnetic resonance imaging were treated by surgery and adoptive immunotherapy with lymphokine-activated killer (LAK) cells and recombinant Interleukin-2 (rIL-2, Cetus). Seventeen patients had glioblastoma, two had high-grade oligodendroglioma, and one patient had two metastatic sarcoma lesions. LAK cells were produced from blood mononuclear cells (MNC) obtained by 2 to 3 leukapheresis procedures and cultured (2.5 × 106 MNC/ml) 3 to 5 days with 1000 units rIL-2/ml. Although LAK cells could be produced from MNC of all patients, those taking steroids or with a low Karnofsky functional status generated, on average, suboptimal LAK cell activity. Age, sex, and serum anticonvulsant levels do not seem to influence a patient's ability to produce LAK cells in vitro. For therapy, cultured MNC (1-15 × 109) containing LAK cells were suspended in saline containing 106 units rIL-2 and injected into tissue surrounding the tumor cavity during craniotomy. For 3 days after their operations, patients received 106 units rIL-2 into the tumor cavity through an Ommaya reservoir. The treatment protocol was tolerated well by all patients, although they all experienced some degree of headache, fever, or lethargy that cleared within a few days of the last rIL-2 injection. When computed tomographic (CT) scans were obtained soon after treatment, areas of low density suggested a greater-than-normal extent of edema around the operative site. At the present time, CT scans indicate that the tumors of seven patients have recurred with an average disease-free interval of 25 ± 6 weeks. Eight patients have remained alive and free of tumor for at least 6 months after surgery and immunotherapy. LAK cell plus rIL-2 immunotherapy for brain tumors is safe and may be efficacious against minimal tumor burden.
Abdominal X-ray and Pathological Findings in Distal Unishunt Obstruction
Authors: Le Roux Peter , Berger Mitchel , Benjamin Denis 
Published: May 2010

Abstract
A new x-ray finding suggesting distal obstruction of the Unishunt is described. Fusiform swelling of the distal slit valve (“pantaloon sign”) seen on an abdominal x-ray film was associated with surgically proven distal shunt obstruction in 8 of 10 patients. No patient with a normally functioning (n = 67) or proximally malfunctioning shunt (n = 6) displayed this abnormality. This finding in association with clinical and computed tomographic evidence of shunt malfunction can direct surgical revision to the appropriate site. The pathology of distal shunt malfunction is also reviewed.
Ventriculopleural Shunts for Hydrocephalus: A Useful Alternative
Authors: Jones Robert Francis Clifford , Currie Bruce George , Kwok Bernard Chi Tack 
Published: May 2010

Abstract
From 1969 to 1979, ventriculopleural shunts were inserted in 29 children with progressive hydrocephalus. A standard Pudenz pump with a Raimondi catheter was used for all but 1 child for whom a Holter valve was used. The shunt functioned adequately in 7, but in 18 it had to be changed as a result of symptomatic pleural effusion. From 1979 to 1982, a further series of 52 other patients received ventriculopleural shunts, and these cases have recently been reviewed. The apparatus used was a Portnoy ventricular catheter or a medium or high pressure Heyer Schulte pump with an antisiphon device and a Salmon distal catheter. Three patients developed a shunt infection. One died with a functioning shunt. Four catheters became blocked by adhesions, and in only 1 patient was a peritoneal shunt substituted as a result of symptomatic effusion.
Presentation of Type I Chiari Malformation after Head Trauma
Authors: Mampalam Thomas J. , Andrews Brian T. , Gelb Douglas , Ferriero Donna , Pitts Lawrence H. 
Published: May 2010

Abstract
An unusual case of Type I Chiari malformation that became symptomatic after closed head injury is reported. The patient manifested transient upper extremity weakness, persistent lower cranial nerve dysfunction, and cerebellar signs that slowly resolved. Magnetic resonance images showed tonsillar ectopia but no displacement of the brain stem or syringomyelia. Type I Chiari malformation should be included in the differential diagnosis of patients who present with upper extremity weakness, lower cranial nerve palsies, or cerebellar signs after trauma.
Intramedullary Dermoid Tumor Diagnosed with the Assistance of Magnetic Resonance Imaging
Authors: Graham Donald V. , Tampieri Donatella , Villemure Jean-Guy 
Published: May 2010

Abstract
Intramedullary dermoid tumors are unusual. Traditional methods of diagnosing spinal tumors have included clinical suspicion, plain roentgenography, myelography, and computed tomography. A case of intramedullary tumor provisionally diagnosed preoperatively by traditional methods and specifically as dermoid tumore with the assistance of magnetic resonance imaging is presented. Diagnosis and treatment of spinal dermoid tumors with an emphasis on magnetic resonance imaging is discussed.
Respiratory Distress Caused by Migration of Ventriculoperitoneal Shunt Catheter into the Chest Cavity: Report of a Case and Review of the Literature
Authors: Gaudio Roberto , De Tommasi Antonio , Occhiogrosso Michele , Vailati Giacomo 
Published: May 2010

Abstract
A case is reported in which the peritoneal catheter of a ventriculoperitoneal shunt migrated into the chest cavity causing an hydrothorax. The three similar cases drawn from the literature are reported.
Metastatic Liposarcoma of the Brain with Response to Chemotherapy: Case Report
Authors: Haft Harold , Wang George C. 
Published: May 2010

Abstract
Metastatic liposarcomas to the brain are rare. The authors describe a patient with a 20-year history of liposarcoma originating in the thigh and metastatic to the brain 18 years later. The brain metastasis was removed by surgery. Nine months later, the patient developed metastases to the retroperitoneum and liver. At that same time, she had recurrent brain metastasis. She was then treated with chemotherapy. The abdominal mass shrank considerably in the beginning, and the recurrent brain metastases totally disappeared. The patient eventually succumbed to widespread liposarcoma. Autopsy revealed extensive liposarcoma involving the retroperitoneum, liver, and lung, but no trace of tumor was found in the brain.
Late Appearance of a Radiodense Lesion at the Site of an Irradiated Metastasis: Neuropathological Findings
Authors: Schnittker Joseph B. , Thomas Harvey G. , Johns Robert D. , Shin Kyu H. , Clark Arthur W. 
Published: May 2010

Abstract
The appearance of contrast-enhancing computed tomographic (CT) lesions at the site of an irradiated brain tumor often has sinister implications. We present the case of a 43-year-old woman who received cranial irradiation as treatment for cerebral metastases from lung cancer. Follow-up radiographic studies revealed complete tumor regression; however, 26 months after treatment, enhanced CT scanning showed a radiodense nodule at the site of one of the previous metastatic deposits. Neuropathological examination of the surgically excised tissue identified benign reactive changes only. The natural history of irradiated brain lesions is discussed.
Positron Emission Tomography in the Detection of Malignant Degeneration of Low-Grade Gliomas
Authors: Francavilla Thomas L. , Miletich Robert S. , Di Chiro Giovanni , Patronas Nicholas J. , Rizzoli Hugo V. , Wright Donald C. 
Published: May 2010

Abstract
The management of low-grade gliomas represents a challenge to the physician as a significant proportion may undergo malignant degeneration to a high-grade tumor. We present the positron emission tomography (PET) scans, using [18F] fluorodeoxyglucose (FDG), of 12 patients who have histological and/or clinical evidence of malignant degeneration of a low-grade glioma. Each scan displays a focal area of hypermetabolism similar to that of malignant gliomas which arise de novo. Three patients also underwent PET scanning prior to malignant degeneration. When the initial scan is compared with the postmalignant degeneration study, a difference in tumoral glucose uptake can be recognized. A region previously shown to be hypometabolic develops focal hypermetabolism as malignant changes evolve. This study displays the utility of FDG-PET in the evaluation of malignant degeneration of low-grade gliomas. The knowledge that a neoplasm has altered its biological behavior may influence subsequent therapeutic options. If these findings can be confirmed in larger series and by other investigators, it is possible that FDG-PET may be adopted as one of the diagnostic tools for guiding the management of low-grade gliomas.
Surgical Treatment of Intracavernous Neoplasms: A Four-Year Experience
Authors: Sekhar Laligam N. , Sen Chandra N. , Jho Hae Dong , Janecka Ivo P. 
Published: May 2010

Abstract
Forty-two patients with neoplasms involving the cavernous sinus had operations between 1983 and 1987. The lesions included 25 benign tumors (e.g., meningioma, neurilemoma) and 17 malignant tumors (e.g., chondrosarcoma, adenoid cystic carcinoma). The cavernous sinus was entered by inferior, anterolateral, or medial extradural approaches or by superior or lateral intradural approaches. The intracavernous internal carotid artery was managed by dissecting tumor away from it or by occlusion and excision with or without direct vein graft reconstruction, based on the results of a preoperative balloon occlusion test. Cranial nerves III, IV, V, and VI usually were dissected from tumor, but in 3 cases of tumor invasion, the excised nerve segment was reconstructed by direct suture or with a sural nerve interposition graft. Twenty-one of the benign tumors and 8 of the malignant tumors were excised totally and the remainder subtotally. On follow-up ranging from 3 to 48 months, one subtotally excised meningioma recurred and was treated with reexcision and adjuvant radiation therapy. Two “totally” excised malignant tumors recurred outside the cavernous sinus at the margins of excision. There was no operative mortality or permanent cerebral morbidity. Postoperatively, the ocular and neurological function of most patients was similar to the preoperative status; in some, it was significantly improved. Thirteen additional patients with intracavernous neoplasms also were evaluated during the same period and followed without operation. The early follow-up information regarding these patients is provided.
Effects of Hydrocephalus and Surgical Decompression on Cortical Norepinephrine Levels in Neonatal Cats
Authors: Lovely Thomas J. , McAllister James P. , Miller David W. , Lamperti Albert A. , Wolfson Barbara J. 
Published: May 2010

Abstract
Norepinephrine (NE) changes during hydrocephalus, and the effects of surgical decompression on these changes, were studied using a new model of neonatal hydrocephalus. Kittens 4 to 10 days old received intracisternal injections of a sterile solution of 25% kaolin. Control kittens were injected similarly with sterile injectable saline. Ultrasonography was used to follow the progression of ventriculomegaly and the initial effects of the shunts. A subgroup of hydrocephalic animals was shunted using a cerebrospinal fluid lumbar-peritoneal catheter. Hydrocephalic animals were killed at approximately 25 days of age (16-21 days after kaolin injection). Surgical decompression was performed at 12, 16, and 17 days after kaolin injection; these animals were killed 30 days after the shunts were inserted. Control animals were killed at 29 and 53 days of age, to correlate with the ages of the hydrocephalic and shunted animals, respectively. Cortical samples equivalent to Brodmann's areas 4, 22, and 17 were measured for NE using high-performance liquid chromatography. Hydrocephalus caused NE levels to decrease significantly in all cortical areas. These alterations followed a rostrocaudal gradient in severity, with mean reductions of 65.8, 83.9, and 95.8% in areas 4, 22, and 17, respectively. Partial recovery occurred in animals that received shunts 16 and 17 days after kaolin injection, such that NE reductions of 75.7, 56.2, and 81.6% were noted in areas 4, 22, and 17, respectively. Shunting at 12 days after kaolin injection produced complete recovery in areas 4 and 22, with only a 67.7% decrease in area 17. These results suggest that the projection fibers from the locus ceruleus are damaged by the direct effects of hydrocephalus. Axotomy or neuropraxia of these fibers could result in decreases in NE throughout the cerebral cortex. In addition, there appears to be a period of time during which surgical decompression will allow neuropraxic fibers to recover with partial restoration of NE levels. Earlier insertion of a shunt appears to allow for more recovery than later decompression.
Angiographic Follow-up Study of Cerebral Arteriovenous Malformations with Reference to Their Enlargement and Regression
Authors: Minakawa Takashi , Tanaka Ryuichi , Koike Tetsuo , Takeuchi Shigekazu , Sasaki Osamu 
Published: May 2010

Abstract
Twenty patients with cerebral arteriovenous malformations (AVMs) were followed up by angiography. Of the 20 AVMs, 16 were nontreated and the remaining 4 were residual. The follow-up periods between the two examinations were from 5 to 28 years, with a median interval of 15 years. At follow-up, the size of the AVM had increased in 4 patients (20%), decreased in 4 (20%), totally regressed in 4 (20%), and was unchanged in 8 (40%). In cases of enlarged AVMs, the patients were all young: from 0 to 11 years old at first angiography and from 6 to 30 at second angiography. The decrease or total regression of the AVM occurred in older patients (over 30 years old at second angiography), and the AVMs were relatively small and fed by single or a few feeders. The patient's age and the size of AVM should be considered when operative indications are discussed.
Improvement of Cortical Perfusion, Intracellular pH, and Electrocorticography by Nimodipine During Transient Focal Cerebral Ischemia
Authors: Tally Philip W. , Sundt Thoralf M. , Anderson Robert E. 
Published: May 2010

Abstract
The alterations in metabolism and cerebral blood flow that occur following transient focal ischemia were studied in rabbits anesthetized with halothane and subjected to transient occlusion of an M2 segment of the middle cerebral artery (MCA). The parameters measured included intracellular brain pH and focal cortical blood flow (fCBF)—assessed by the umbelliferone technique—electrocorticograms, and cortical microcirculatory changes. A gradient of ischemia developed in the cortex between the patent and occluded vessels. Cortical sites with moderate and severely diminished flow were examined as a function of time before and after occlusion. Mean preocclusion fCBF was 50.8 ± 2.1 ml/100 g/min, and brain pH was 6.99 ± 0.04. Following occlusion, fCBF fell to 14.6 ± 2.3 ml/100 g/min, with an intracellular pH of 6.53 ± 0.03 in sites of severe ischemia in the territory of the occluded vessel. Sites between the patent and occluded branches revealed moderate changes in fCBF and intracellular pH of 26.7 ± 3.6 ml/100 g/min and 6.74 ± 0.03 ml/100 g/min, respectively. Sites adjacent to the patent M2 branch remained similar to baseline. Pretreatment intravenously with nimodipine, a dihydropyridine class of Ca2+ channel antagonist, improved flow in the territory of the occluded segment of the middle cerebral artery to 30.6 ± 2.2 ml/100 g/min, while maintaining the brain pH at 6.83 ± 0.03. Similarly, at sites intermediate between the patent and occluded M2 segments of the MCA, cortical blood flow remained at 53.5 ± 4.0 ml/100 g/min, and the pH at 6.95 ± 0.04, in 10 animals pretreated with nimodopine. This effect was apparently achieved by blocking the secondary, ischemia-induced vasoconstriction known to occur in areas of focal incomplete ischemia.
The diphenylalkylamine class Ca2+ channel blockers was examined using verapamil. This was found to be without significant effect. The vehicle carrying nimodopine was also without effect. To authenticate further the reliability of MCA occlusion, a separate group of animals was examined with cautery occlusion of the M2 segment of the MCA. Nimodopine had an effect in this group of animals identical to that caused by occlusion of the vessel with a clip. Visual inspection of the cortex in control and treated animals revealed a marked difference in the development of cortical pallor and microcirculatory changes. We conclude that nimodopine protects the conducting vessels against the secondary vasoconstriction known to occur in areas of focal incomplete ischemia, and thus increases collateral flow. This agent may have the potential for brain protection in areas of incomplete focal ischemia from occlusion of a single major vessel.
Stereotactic Drainage of Aspergillus Brain Abscess with Long-Term Survival: Case Report and Review
Authors: Goodman Michael L. , Coffey Robert J. 
Published: May 2010

Abstract
Aspergillus species are second only to Cryptococcus neoformans as the most common cause of fungal infections of the central nervous system in immunocompromised patients. Survival following treatment of Aspergillus brain abscess has been reported only 4 times. In each case, craniotomy was performed for abscess drainage. We present a case of long-term survival following stereotactic drainage of a bilateral Aspergillus brain abscess. In all reported cases, including the present one, histological examination of the abscess contents established the correct diagnosis. Amphotericin B was used in combination with operation in 4 of the 5 cases of long-term survival.