bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anterior or Posterior Approach to the Cervical Spine: An Anatomical and Radiographic Evaluation and Comparison
Authors: Raynor Richard B. 
Published: May 2010

Abstract
Both the anterior and the posterior approaches are used in the treatment of cervical radiculopathy. An evaluation of the advantages and limitations of each method as compared to the other was made in isolated cervical spine segments. With a posterior approach, a quarter to a half of the facet joint must be removed to unroof the neural foramen. Anterior osteophytes in the region of the uncovertebral joint are difficult to reach from posteriorly unless they are very large. Using an anterior approach the amount of root decompression is easily overestimated. The lateral limits of the decompression must be beyond direct visualization to equal that obtained posteriorly. Osteophytes in the region of the uncovertebral joints are easily reached. Because some roots leave the dural tube a significant distance above the interspace, a soft disc fragment may migrate out of the interspace and behind the body to compress the root. This fragment may be missed from the anterior approach unless the root anatomy is evaluated carefully. X-ray films were taken at each step of the surgical procedures and were compared. A final set was taken using radiopaque markers to identify key structures. Plain x-ray films of the cervical spine reflect few if any of the anatomical alterations accomplished by operation. Oblique x-ray films do not visualize the entrance of the anatomical foramen, and osteophytes seen on this view may be well anterior in the neural canal.
Clinical Indications for Computer-assisted Myelography
Authors: Barrow Daniel L. , Wood James H. , Hoffman James C. 
Published: May 2010

Abstract
Computer-assisted myelography (CAM) is a technique in which computed tomography (CT) is combined with the intrathecal administration of metrizamide to demonstrate the spinal cord and surrounding structures. This retrospective study of 139 CAMs performed at Emory University Hospital included 125 CAMs that were preceded by routine metrizamide myelography (secondary CAM). The remaining 14 CAMs were primary studies without concomitant myelography. These CAMs and conventional myelograms were reviewed to provide indications for the use of CAM as a replacement for other radiodiagnostic studies or as an adjunct to radiological diagnosis. Eighty-one CAMs (58%) were positive for some pathological process. Of the 69 secondary CAMs demonstrating a pathological condition, 46 (67%) revealed some aspect of the lesion not apparent on routine metrizamide myelography. In no case with positive myelography was CAM negative. However, conventional myelography often added valuable diagnostic information. Although high resolution CT has allowed limited visualization of the spinal cord. CAM is often indicated for cases in which diagnosis requires more definition of cervicomedullary, extradural, intradural, extramedullary, and intramedullary lesions. Our clinical review found CAM to be extremely useful in the diagnostic evaluation of pathological conditions involving the spine and spinal cord and suggests clinical indications for the use of CAM based upon selected illustrative cases. Furthermore, CAM seemed to be superior to other radiological procedures in certain instances, such as in cases of spinal dysraphism and in the evaluation of lesions at the foramen magnum. Until more experience is obtained using spinal CT and CAM, CAM should not replace myelography altogether. The present study indicates that, rather than replacing conventional CT and myelography, CAM should be used as a primary study in situations where it has been shown to be superior and as a complementary study when other neurodiagnostic examinations are equivocal or nondiagnostic.
Althesin in the Management of Head Injuries
Authors: Mcllhany Michael , Rapport Richard , Dunn Robert , Namazie Mohamed , Delilikan Alex 
Published: May 2010

Abstract
The aggressive treatment of major craniocerebral trauma has received recent attention. Barbiturate administration has been beneficial in some cases of sustained, uncontrolled intracranial hypertension. One major disadvantage of pentobarbital narcosis is the long half-life of the drug (15 to 48 hours). We have used Althesin, an intravenous steroid anesthetic (alfaxalone and alfadolone acetate; Glaxo Laboratories Ltd., Greenford, Middlesex, England), in eight seriously head-injured patients. Althesin combines the theoretical advantages of pentobarbital in the management of head trauma with almost immediate reversibility (serum half-life, 1.6 minutes). Raised intracranial pressure and clinical outcome seem to be influenced favorably and the side effects are negligible when the drug is administered by continuous intravenous infusion over several days. Further study of this compound in the management of head trauma seems warranted.
Arachnoid Cyst of the Fourth Ventricle Manifesting Normal Pressure Hydrocephalus
Authors: Korosue Kazuyoshi , Tamaki Norihiko , Fujiwara Kiyoshi , Matsumoto Satoshi 
Published: May 2010

Abstract
The authors report a patient with the syndrome of normal pressure hydrocephalus who had an arachnoid cyst in the 4th ventricle. Ventriculoperitoneal shunting followed by removal of the cyst resulted in a complete recovery.
Arachnoiditis Presenting as a Cervical Cord Neoplasm: Two Case Reports
Authors: Bose Bikash , Myers Donald L. , Osterholm Jewell L. 
Published: May 2010

Abstract
Neurological evaluation supplemented by myelography has been highly successful in diagnosing spinal cord tumors. Our experience shows that a widening of the cord on myelography is not always diagnostic of spinal cord tumors. Two patients who presented clinically with evidence of spinal cord tumor and had a widening of the cord on myelography were found to have severe cervical arachnoiditis without any evidence of intrinsic cord abnormality. Hence, cervical arachnoiditis should be considered in the differential diagnosis of spinal cord tumor on myelography.
Penetration of Nafcillin, Methicillin, and Cefazolin into Human Brain Tissue
Authors: Frame Peter T. , Watanakunakorn Chatrchai , McLaurin Robert L. , Khodadad Ghahreman 
Published: May 2010

Abstract
To determine the penetration of the antistaphylococcal antibiotics, nafcillin, methicillin, and cefazolin, into brain tissue, we gave to each of 27 patients undergoing craniotomy and brain biopsy one of the antibiotics in a 2-g intravenous infusion just before operation. At the time of brain tissue removal (30 to 225 minutes after the start of the infusion). a serum specimen was obtained, and tissue and serum were assayed for antibiotic concentration. Eleven of 13 brain specimens contained detectable nafcillin concentrations between 0.36 and 11 μg/g of tissue (mean. 2.7 μg/g for all 13 specimens). Fourteen of 18 brain tissue specimens contained detectable methicillin concentrations between 0.56 and 5.0 μg/g of tissue (mean, 2.0 μg/g for all 18 specimens). Ten of 11 brain tissue specimens contained detectable cefazolin concentrations between 2.0 and 40 μg/g of tissue (mean, 10.6 μg/g for all 11 specimens). Each antibiotic penetrated “abnormal” brain tissue better than “relatively normal” brain tissue. Because nafcillin is more active against Staphylococcus aureus, we conclude that nafcillin is preferable to methicillin for the therapy of central nervous system staphylococcal infections. Cefazolin achieves higher brain tissue concentrations than the penicillins, but has not been clinically evaluated for the therapy of central nervous system infections.
Large and Giant Paraclinoid Aneurysms: Surgical Techniques, Complications, and Results
Authors: Heros Roberto C. , Nelson Paul B. , Ojemann Robert G. , Crowell Robert M. , DeBrun Gerard 
Published: May 2010

Abstract
Twenty-five patients with giant (&gt;25 mm in diameter) and 9 patients with large (15 to 25 mm in diameter) aneurysms of the internal carotid artery in the ophthalmic or paraophthalmic region are reviewed. In 23 of these patients the aneurysm was clipped directly. There was 1 death in this group, and none of the survivors had disabling neurological complications outside the visual system. The other 11 patients were treated by a trapping procedure or by either common carotid ligation or internal carotid ligation in the neck. Of the 5 patients treated by internal carotid ligation preceded by an extracranial to intracranial bypass graft, 3 developed embolic complications, which in 1 patient resulted in death. One of the 4 patients treated by ligation of the common carotid artery died 1 year later from a recurrent subarachnoid hemorrhage. Of the total group, 18 patients had visual loss preoperatively as a result of aneurysmal compression; in 10 the vision was improved by operation, in 3 it was made worse, and in 2 it was unchanged. In another patient the vision continued to deteriorate slowly after common carotid occlusion, and the other 2 patients died postoperatively before vision could be assessed. The complications in the patients are described and analyzed in detail. Maneuvers found to be of value in the direct approach to these lesions are described. Of these, exposure of the internal carotid artery in the neck for temporary occlusion during clipping and thorough drilling of the anterior clinoid process and unroofing of the optic canal were particularly helpful. The literature on indirect methods of treatment by carotid occlusion with and without bypass graft is reviewed with special reference to the complications and effectiveness of each alternative. Based on this review of the literature and our experience, a treatment scheme is suggested for these aneurysms depending on their mode of presentation.
Tension Pneumocephalus after Posterior Fossa Craniotomy
Authors: Toung Thomas , Donham Robert T. , Lehner Anthony , Alano Jean , Campbell James 
Published: May 2010

Abstract
Four cases of tension pneumocephalus after either posterior fossa craniotomy or translabyrinthine resection of acoustic neuroma with or without nitrous oxide anesthesia are described. Three of the operations were performed with the patient in the sitting position, and one was done with the patient in the lateral position. Of the three cases operated in the sitting position, no nitrous oxide was used at any time during anesthesia in one. Two patients failed to regain consciousness after the termination of anesthesia, and the other two developed the sudden onset of neurological symptoms 1 to 1.5 hours after the operation. In all cases computed tomography disclosed a large subdural collection of air. Re-exploration of the surgical wound or twist drill aspiration of the subdural air resulted in prompt recovery of neurological status in three patients, whereas the other patient's neurological status improved gradually without any specific treatment. The role played by nitrous oxide, the mechanisms by which air enters the intracranial space, the contributory factors, and the predisposing surgical conditions of tension pneumocephalus are reviewed and discussed. Dependent drainage of the cerebrospinal fluid, especially in a patient with coexisting hydrocephalus, seems to be the most important factor for the development of this complication.
Early Operation for Ruptured Intracranial Aneurysms
Authors: Yamamoto Isao , Hara Makoto , Ogura Koichiro , Suzuki Yoshio , Nakane Toshichi , Kageyama Naoki 
Published: May 2010

Abstract
The relationship between the results of early operation for ruptured intracranial aneurysms (72 cases) and the preoperative computed tomographic (CT) findings was studied. There was a correlation among the surgical results, the development of symptomatic vasospasm, and high density on the preoperative CT scan, particularly the presence of a localized, thick layer in the subarachnoid space. However, no relationship was found between the occurrence of ventricular enlargement and the preoperative CT findings. Cisternal or ventricular drainage might contribute to an uncomplicated postoperative course for patients with severe subarachnoid clot shown on the preoperative CT scan.
Long Term Results of Stereotactic Thalamotomy for Cerebral Palsy
Authors: Broggi G. , Angelini L. , Bono R. , Giorgi C. , Nardocci N. , Franzini A. 
Published: May 2010

Abstract
A group of 33 patients (between 10 and 30 years old and with average intelligence) underwent stereotactic surgery for abnormal movements due to cerebral palsy. Neurological, neurofunctional, and neuropsychological examinations were performed pre- and postoperatively. The length of follow-up ranged between 1 and 4 years. The clinical results are reported and discussed in relation to the targets, the side of the lesion, and the clinical picture. Our data show that better results are obtained in patients with tremor and hyperkinesias; dystonia is improved to a lesser extent, whereas spasticity tends to recur. Operation is more effective for patients with unilateral signs than for patients with bilateral symptoms. The clinical results are stable in time, and the side effects fade away after a few months.
Dural Sinus Pressure as Related to Neurosurgical Positions
Authors: Iwabuchi Takashi , Sobata Eiji , Suzuki Mikio , Suzuki Shigeharu , Yamashita Masao 
Published: May 2010

Abstract
Taking advantage of the exposure of dural sinuses during craniotomies, we measured confluens sinuum pressure by direct catheterization. The influence of various surgical positions and of other factors on confluens sinuum pressure was studied. When the upper half of the body was raised, the confluens sinuum pressure decreased to reach zero at + 25º when the angle was +90º, a marked negative pressure of −12.7 ± 3.0 cm H2O (mean ± SD) was observed in adults. In children under 6 years of age, however, such negative pressure was not observed even at an angle of +90º. The confluens sinuum pressure was 2.7 ± 0.6 cm H2O with the patient in the reverse jackknife position (supine position with the upper and lower halves of the body elevated ca. 20º), 3.0 ± 0.8 in the sea lion position (prone position with the upper and lower halves of the body elevated ca. 20º and with the neck hyperextended), 5.8 ± 0.9 in the prone position, and 5.9 ± 1.7 in the supine position. In the supine and the sitting positions, the confluens sinuum pressure was elevated well enough by jugular compression to prevent air embolism. Positive pressure respiration did not raise the confluens sinuum pressure. The pressure of the jugular bulb measured by percutaneous direct puncture did not always reflect the confluens sinuum pressure, probably because subcutaneous hematoma produced an effect similar to that of jugular compression.
Traumatic Posterior Atlantoaxial Dislocation without Neurological Deficit: Case Report
Authors: Jamshidi Saied , Dennis Michael W. , Azzam Charles , Karim Najmaldin 
Published: May 2010

Abstract
A case is presented in which a patient sustained a closed head injury with subsequent acute subdural hematoma and delayed posterior dislocation of the atlas without fracture of the odontoid process and with an intact C-1 arch. The subdural hematoma was treated operatively. The atlas dislocation was managed with closed reduction without manipulation and subsequent posterior fusion of C-1, C-2, and C-3. The patient was intact neurologically on admission and remained so throughout his hospitalization.
Choroid Plexus Papilloma of the Third Ventricle: Case Report and Review of the Literature
Authors: Gradin Wesley C. , Taylon Charles , Fruin Alan H. 
Published: May 2010

Abstract
Choroid plexus papilloma (CPP) is a rare intraventricular neoplasm occurring primarily in the lateral ventricles of children and the 4th ventricle of adults. We describe the third reported case of a cystic CPP of the 3rd ventricle and review the pertinent literature.
Real-Time Ultrasonography: A Useful Tool in the Evaluation of the Craniectomized, Brain-injured Patient
Authors: Ostrup Richard , Bejar Raul , Marshall Lawrence 
Published: May 2010

Abstract
Real-time ultrasonography is being used increasingly to establish the diagnosis of and serially assess intraventricular hemorrhage and hydrocephalus in neonates. The procedure requires an open fontanel because scatter from the bone occurs from direct application of the transducer to the skull and bone density precludes satisfactory imaging. With an adult, under circumstances where a bone flap is left out after intracranial procedures and the patient's clinical status is such that the patient cannot be transferred for computed tomographic scanning, real-time ultrasonography allows a safe, noninvasive, bedside demonstration of ventricular size, degree of shift of midline structures, and intraparenchymal and intraventricular lesions.
Spontaneous Seeding of Medulloblastoma: Results of Cerebrospinal Fluid Cytology and Arachnoid Biopsy from the Cisterna Magna
Authors: Tomita Tadanori , McLone David G. 
Published: May 2010

Abstract
Five children with cerebellar medulloblastoma underwent cytological study for neoplastic cells in the cerebrospinal fluid (CSF) from the lateral ventricle and cisterna magna and biopsy of the arachnoid of the cisterna magna before the manipulation of a medulloblastoma. In all cases, seeding of neoplastic cells was present in the CSF or arachnoid of the cisterna magna, whereas the ventricular fluid was negative for neoplastic cells. This study suggests that medulloblastoma seeds spontaneously into the subarachnoid space, thus supporting the need for postoperative whole neuraxis radiation.
Computed Tomographic Guidance Stereotaxis in the Management of Intracranial Mass Lesions
Authors: Apuzzo Michael L.J. , Sabshin James K. 
Published: May 2010

Abstract
A prototype Brown-Roberts-Welles stereotactic instrument has been used as both a diagnostic and a therapeutic surgical adjunct in cases of intracranial mass lesions. Eighty-three procedures (142 point placements) required computerized guidance stereotaxy. The unit accomplished point intracranial access with an accuracy of greater than 1 mm. Pathological processes included a variety of neoplasms (56 cases), strokes (7 cases), and infections (20 cases) affecting deep regions of the cerebral hemispheres, the ventricular system, the cerebellum, and the rostral brain stem. Procedures were undertaken with the patient under local anesthesia for biopsy (300 point specimens), culture, evacuation, aspiration, endoscopic excision, and implantation of radioisotopes. The techniques and instrumentation for each of these procedures are described. Procedural objectives were satisfactorily accomplished with no mortality and an overall complication rate of 4%. Recovery of tissue specific to establish a histological diagnosis or the etiological factors related to each disease process was realized in 94% of the cases. These results were obtained with scanner utilization times averaging 15 minutes and procedurally related patient recovery periods of less than 4 hours. The value and adaptability of the instrumentation and techniques are illustrated, and potential future applications are discussed.
Pediatric Brain Stem Tumors: Radiographic, Pathological, and Clinical Correlations
Authors: Berger Mitchel S. , Edwards Michael S. B. , LaMasters David , Davis Richard L. , Wilson Charles B. 
Published: May 2010

Abstract
A retrospective analysis of the case histories of 21 pediatric patients (ages, 2.5 to 18 years) with a histologically proven diagnosis of brain stem glioma was performed to determine whether patterns of radiographic appearance could be correlated with pathology. Based on the computed tomographic or pneumoencephalographic appearance of the tumor at the time of clinical diagnosis, tumors were divided into four types: central intrinsic (Type I), central exophytic expansion into the 4th ventricle (Type II), eccentric exophytic expansion not involving the 4th ventricle (Type III), and both eccentric and central exophytic expansion (Type IV). Regardless of the radiographic classification, all patients except one, who harbored a well-differentiated astrocytoma in the area of the pons, had an anaplastic astrocytoma (n = 14 or a glioblastoma mutiforme (n = 6). There was no appreciable difference in survival between patients with either tumor histology. The presence of a cystic component did not affect survival. High resolution computed tomographic scans, with reconstructed images of the posterior fossa, can predict the presence and location of brain stem tumors and associated cysts and probably the histological nature of the tumor.
Thoracic Disc Herniation: Operative Approaches and Results
Authors: Sekhar Laligam N. , Jannetta Peter J. 
Published: May 2010

Abstract
In a series of 12 cases of thoracic disc herniation operated upon at the University of Pittsburgh, 4 different operative approaches were used. These included laminectomy in 2 early cases, posterolateral extrapleural operation in 5 cases, transthoracic operation in 3 cases, and transpedicular operation in 2 cases. The relative merits of the various approaches are discussed in this paper. The clinical presentation, radiological features, and follow-up data are also presented. Precise preoperative radiological diagnosis was essential in planning the operative strategy. The posterolateral and transpedicular approaches were both satisfactory, but the former had some advantages over the latter. With a mean follow-up period of 5 years, 5 patients were cured, 5 were improved, and 1 was unchanged. One patient was worse due to coexistent amyotrophic lateral sclerosis.
Early Correction of Orbicularis Oculi Paralysis with an Encircling Silicone Prosthesis
Authors: Jelks Glenn W. , Ransohoff Joseph 
Published: May 2010

Abstract
Fifteen patients with paralysis of the 7th and 5th nerves or the 7th nerve alone were treated with an encircling silicone prosthesis. There has been no serious ocular complication observed over the last 3 years. The prosthesis has been removed in 9 of the 15 patients in whom good 7th nerve recovery has occurred. In the remaining 6 patients, the prosthesis is being well tolerated.
Embolization of a Superficial Temporal Artery to Middle Cerebral Artery Bypass: Case Report
Authors: Conley Frances K. 
Published: May 2010

Abstract
This case history of a man with bilateral carotid artery occlusions presents angiographic documentation of the embolization of a superficial temporal-middle cerebral artery bypass. The embolic source was thrombotic and/or atheromatous debris that had collected in the persistent stump of one of the occluded internal carotid arteries.
Pineal Region Meningioma: Report of Two Cases and Literature Review
Authors: Piatt Joseph H. , Campbell Gerald A. 
Published: May 2010

Abstract
The case histories of two patients with pineal region meningiomas are presented. Comparable cases reported previously in the literature are reviewed. A characterization of the clinical features of this lesion is formulated and compared with the clinical appearance of patients with other types of pineal masses. This characterization is placed in perspective by a brief discussion of the diagnostic evaluation of patients with pineal region tumors.
Chiari Malformation Presenting in Adults: A Surgical Experience in 127 Cases
Authors: Joseph Levy Walter , Mason Laura , Hahn Joseph F. 
Published: May 2010

Abstract
We reviewed 127 patients who were operated upon for adult presentation Chiari malformation and made six conclusions: (a) The clinical examination remains crucial in the diagnosis. (b) The surgical anatomy is highly varied. (c) Syrinxes can be missed on preoperative contrast studies. (d By a conservative grading system, we determined that 46%; of the patients improved during long term follow-up. One-quarter deteriorated over the long run in spite of any treatment. (e) The overall results did not differ whether the treatment was plugging of the central canal plus decompression or decompression alone. (f) In patients with progression, plugging of the central canal obtained superior results. A review of the literature shows that the natural history of this complex disease process has not been established. This history is needed to identify the course of what may be several important factors that lead to the pathological condition in this disease.