bluuebunny/crossref_metadata_2025_split huggingface dataset:
General and local hypothermia of the brain in the treatment of intractable epilepsy
Authors: Šourek K. , Trávníček V. 
Published: May 2009

✓ Twenty-five cases of intractable epilepsy were treated by combined deep general and local extravascular brain hypothermia plus single doses of pentothal (Thiopental) or diazepam. The final local temperature of the brain in 21 patients was below 24°C, the rectal temperatures being 27° to 30°C. There was one death 6 weeks after surgery, and in two patients slight neurological deficits were found at 3 and 6 months postoperatively.
In 15 patients in whom at least 1 year had elapsed since surgery, the frequency and intensity of the seizures were reduced by 50% in two, reduced to a single seizure in five, eliminated in four, and unaltered in four. The fair and excellent results included 60% of the group. In three patients improvement in behavior and emotional stability were observed postoperatively; this change was independent of the reduction of the frequency of seizures. Postoperative changes in the electroencephalogram were less frequent than changes in the frequency of seizures and also were completely independent of the clinical results.
Effects of hyperventilation, CO2, and CSF pressure on internal carotid blood flow in the baboon
Authors: Rudenberg F. Hermann , McGraw C. Patrick , Tindall George T. 
Published: May 2009

✓ The combined effect upon cerebral blood flow (CBF) of an elevation of cerebrospinal fluid pressure (CSFP) and changes in respiratory CO2 was studied in nine baboons under chloralose anesthesia. The animals were mildly hyperventilated and provided with increasing amounts of CO2 in O2-air. Arterial CO2 tensions (PaCO2) increased from 17 to 58 mm Hg. Internal carotid blood flow (ICBF) was measured at normal CSFP and at hydrostatically maintained 50 mm Hg CSFP. It was found that: 1) end-tidal CO2 may be used as a substitute for arterial PaCO2 determinations; 2) this elevation of CSFP has little effect on ICBF during hypercapnia and normocapnia; however, 3) during hypocapnia the ICBF is reduced an additional 20% when CSFP is elevated; that is, ICBF is reduced 50% from normal when end-tidal CO2 is reduced to 2% at this elevated level of CSFP.
Caution should be exercised during hyperventilation therapy particularly if the elevated CSFP or intracranial pressure (ICP) is not reduced to approach normal levels; in these conditions, the combination of decreasing PaCO2 and elevated ICP may reduce CBF below critical levels and thus lead to cerebral hypoxia.
Cerebral arterial blood flow and aneurysm surgery
Authors: Nornes Helge , Wikeby Per 
Published: May 2009

✓ Cerebral arterial blood flow was monitored in 22 patients undergoing surgery for intracranial saccular aneurysms. An electromagnetic flow probe was used to record the internal carotid artery (ICA) flow in the neck or intracranially in seven patients. The ICA flow ranged between 100 and 175 ml/min (average 144 ml/min). Intracranial flow measurements with specially designed probes were made in 17 patients. The middle cerebral artery (MCA) showed flow values between 75 and 120 ml/min (average 97 ml/min). Flow figures recorded from the proximal anterior cerebral artery (ACA) were lower (average 65 ml/min), and had a wider range from 30 to 110 ml/min.
Test occlusion of the terminal ICA showed a retrograde flow in the proximal ACA to the MCA ranging from 15 to 125 ml/min (average 78 ml/min). This test was used to investigate the collateral potential of the anterior portion of the circle of Willis, which is essential to the decision of whether to undertake trap ligation procedures in this location. Flow monitoring in the parent vessel was also of use in some patients to assess flow conditions after the clipping of the aneurysm neck.
Autoregulation and CO2 responses of cerebral blood flow in patients with acute severe head injury
Authors: Enevoldsen Erna M. , Jensen Finn T. 
Published: May 2009

✓ Regional cerebral blood flow (rCBF), cerebral intraventricular pressure (IVP), systemic arterial blood pressure, and cerebral ventricular fluid (CSF) lactate and pH were studied repeatedly in 23 patients during the acute phase of severe brain injury lasting from 3 to 21 days after the trauma. Cerebrovascular autoregulation was tested repeatedly by means of angiotensin infusion in 21 of the patients, and CO2 response in 14 by means of passive hyperventilation. The pressure in the brain ventricles was measured continuously in all patients and kept below 45 mm Hg during the study. If the IVP increased more than 10 mm Hg during the angiotensin infusion (as in one case), the autoregulation test was considered contraindicated and the angiotensin infusion was discontinued.
Dissociation between cerebrovascular autoregulation and CO2 response was a common phenomenon. Typically, autoregulation appeared preserved in the most severely injured areas of the cerebral cortex when the patient was deeply comatose, but deteriorated concomitantly with recovery; by the time the patient became alert, the autoregulation was always impaired. The CO2 response was impaired only in patients who were deeply comatose and had attacks of decerebrate rigidity; during recovery the CO2 response became normal. Thus, preserved autoregulation associated with impaired CO2 response indicated very severe brain damage, whereas impaired autoregulation associated with preserved CO2 response suggested moderate or severe brain damage in recovery. These paradoxical observations raise the question whether the preserved autoregulation seen in severely injured brain tissue is a true autoregulation caused by an active vasoconstrictor response to an increase in blood pressure.
The fate of autogenous grafts to the spinal dura
Authors: Keller Jeffrey T. , Dunsker Stewart B. , McWhorter Joe M. , Ongkiko Carlos M. , Saunders Mary C. , Mayfield Frank H. 
Published: May 2009

✓ An experimental study was designed to compare the efficacy of autogenous fat and Gelfoam in minimizing scar tissue attachment to the dura and nerve roots. A multiple level lumbar laminectomy was performed in 20 dogs, and Gelfoam and autogenous fat were placed in the epidural space at two laminectomy sites, over the dura, interposed between the overlying paraspinal muscles and the dura. A third lumbar laminectomy site in each dog served as a control. The animals were sacrificed after different time periods (3, 6, 12, 18, and 24 weeks), and the specimens were examined histologically and histochemically. The colloidal iron-periodic acid Schiff-Bismarck brown-picric acid (CI-PAS-BB-PA) and high iron diamine-Alcian blue 8Gx (HID-AB) techniques were used to demonstrate connective tissues and glycosaminoglycans.
The scar at the laminectomy sites where Gelfoam was placed and at the control sites was composed of dense irregular connective tissue. Examination of the laminectomy sites where autogenous fat was used revealed less scar tissue. In addition, there was a layer of fat with a slight increase in intercellular connective tissue fibers interposed between the overlying erector spinae musculature and the dura. Our results indicate that autogenous fat interposed between the dura and the overlying paraspinal musculature serves as a barrier limiting the growth of connective tissue into the spinal canal. We could find no evidence that Gelfoam prevented the ingrowth of scar tissue into the operated area.
Hypothalamic hypothyroidism and hypogonadism in prolonged traumatic coma
Authors: Fleischer Alan S. , Rudman Daniel R. , Payne Nettleton S. , Tindall George T. 
Published: May 2009

✓ Prolonged coma after head trauma is associated with depletion of 3′,5′cyclic adenosine monophosphate (cAMP) in the cerebrospinal fluid (CSF). Because cAMP has previously been implicated in neuroendocrine secretion, this study examines the pituitary-hypothalamic function in 15 adult male patients (to exclude the effects of puberty and menses) with traumatic coma lasting longer than 2 weeks. Ventricular CSF cAMP was measured at 2- to 4-day intervals for 10 to 25 days. Simultaneously, plasma hormone concentrations were also determined.
In all 15 cases, CSF cAMP and plasma levels of thyroid-stimulating hormone (TSH), thyroxine (T4), free T4, triiodothyronine (T3), luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone became subnormal. In 11 patients whose level of consciousness fluctuated, the reduction in plasma T4 and testosterone were proportional to both severity of coma (r > 0.81, p < 0.05) and depletion of CSF cAMP (r > 0.81, p < 0.05). In four patients who remained deeply comatose for 17 to 25 days, the hypothyroidism and hypogonadism persisted. In six patients who regained consciousness, both endocrine defects improved partially or completely. Injection of 1) thyrotrophic-releasing hormone and 2) gonadotrophic-releasing hormone elicited normal or supernormal increases in plasma concentrations of 1) TSH, and 2) LH and FSH, reduced, respectively, suggesting a suprahypophyseal deficiency. These observations demonstrate that suprahypophyseal hypothyroidism and hypogonadism may occur regularly in patients with traumatic coma lasting longer than 2 weeks.
Results of urinary diversion in patients with myelomeningocele
Authors: Smith Harold P. , Russell John M. , Boyce William H. , Alexander Eben 
Published: May 2009

✓ Among 481 children with myelomeningocele seen at the North Carolina Baptist Hospital since 1949, 46 have undergone a urinary diversion procedure, as follows: ileal loop in 43; sigmoid loop in two; and transverse colon conduit in one. The indications for diversion were incontinence in 28, urinary infection or pyelonephritis in 27, and hydronephrosis, pyelocaliectasis, and reflux in 12 patients. No deaths resulted from the diversionary procedures. One patient required early surgical revision and seven patients required late surgical revision. Two patients have since died, 44 have been followed for an average of 7.9 years, 15 for more than 10 years. Overall, of 26 patients with normal prediversionary intravenous pyelograms (IVP's), 88% now have normal or nearly normal IVP's; of 14 patients with abnormal prediversionary IVP's, 79% now have normal, improved, or unaltered IVP's. Renal function has remained normal in all 44 patients, and renal calculi have developed in 10 patients.
Ileal loop diversion appears to convert a high-pressure system into a low-pressure system, thereby helping to prevent further renal damage. This procedure tends to stabilize, rather than improve, urinary-tract function. For these children already so incapacitated by their basic disease, this goal is acceptable, particularly since it also provides continence and independence from parental nursing.
Recent diagnostic experience with subdural empyema
Authors: Luken Martin G. , Whelan Margaret A. 
Published: May 2009

✓ The authors review the Neurological Institute experience of six cases of subdural empyema in the 4 years since the introduction there of computerized tomography (CT) scanning. Four patients had no known prior neurological disease, and presented with the classical clinical syndrome of fever, depressed sensorium, and focal seizures; three of these patients had histories or radiographic evidence of sinus disease. The two remaining patients had undergone earlier drainage procedures for chronic subdural hematomas, and presented without neurological symptoms but with low-grade fever and signs of local wound infection. All of the patients of the former (primary) empyema group had technically satisfactory contrasted CT scans at a time when the clinical syndrome was fully developed, and none revealed the subdural collection. Angiograms were performed in three of these cases and were uniformly successful in demonstrating the collections and suggesting their inflammatory natures. Both secondary empyemas were readily visualized by CT, and showed characteristic brightly enhancing membranes.
It is concluded that primary and secondary subdural empyemas differ both in clinical presentation and in accuracy of CT diagnosis. In the former group, evidence of sinus disease is suggestive but does not by its absence exclude a purulent subdural collection. In patients with the typical clinical syndrome, reliance on CT is hazardous, and angiography is the diagnostic procedure of choice.
Long-term follow up of patients surgically treated by the far-lateral approach for foraminal and extraforaminal lumbar disc herniations
Authors: Porchet François , Chollet-Bornand Anne , de Tribolet Nicolas 
Published: May 2009

Object. This study was undertaken to evaluate the long-term benefit in 202 patients who were surgically treated via a microsurgical far-lateral approach for foraminal or extraforaminal lumbar disc herniations.
Methods. All patients underwent surgery at the authors' institute since 1987 and represented 6.5% of all lumbar spinal disc surgeries. There were 67 women and 135 men who ranged in age from 19 to 78 years (mean age 58 years). All patients had unilateral leg pain due to lumbar disc herniations into or lateral to the lateral interpedicular compartment. One patient underwent surgery at the L1–2 level, nine at L2–3, 48 at L3–4, 86 at L4–5, and 58 at the L5—S1 level. The mean follow-up period was 50 months (range 12–120 months). Outcome was defined as excellent (no pain), good (some back pain), fair (moderate radiculopathy), and poor (unchanged or worse) based on Macnab classification. Overall, excellent and good results were achieved in 62 (31%) and 85 (42%) patients, respectively, and fair and poor results in 40 (20%) and 15 (7%) patients, respectively. Of 11 recurrent disc herniations, four presented in an extreme-lateral position, five in a paramedian location, and two on the contralateral side. There were three minor complications related to surgery, seven general complications, and no case of spinal instability.
Conclusions. The far-lateral approach is a safe, effective procedure that avoids the risk of secondary spinal instability.
Percutaneous spinal fusion using bone morphogenetic protein-2 gene therapy
Authors: Alden Tord D. , Pittman Debra D. , Beres Elisa J. , Hankins Gerald R. , Kallmes David F. , Wisotsky Benjamin M. , Kerns Kelvin M. , Helm Gregory A. 
Published: May 2009

Object. Gene therapy has many potential applications in neurosurgery. One application involves bone morphogenetic protein-2 (BMP-2), a low-molecular-weight glycoprotein that induces bone formation in vivo. Numerous studies have demonstrated that the BMP-2 protein can enhance spinal fusion. This study was undertaken to determine whether direct injection of an adenoviral construct containing the BMP-2 gene can be used for spinal fusion.
Methods. Twelve athymic nude rats were used in this study. Recombinant, replication-defective type 5 adenovirus with the cytomegalovirus (CMV) promoter and BMP-2 gene (Ad-BMP-2) was used. A second adenovirus constructed with the CMV promoter and β-galactosidase (β-gal) gene (Ad-β-gal) was used as a control. In three groups (four rats each) 7.5 µl of virus (5 × 108 particles/µl) was injected percutaneously and paraspinally at the lumbosacral junction: Group 1 received Ad-BMP-2 bilaterally; Group 2 received Ad-BMP-2 on the right, Ad-β-gal on the left; and Group 3 received Ad-β-gal bilaterally. Computerized tomography (CT) scans of the lumbosacral spine were obtained at 3, 5, 8, and 12 weeks. At 12 weeks, the animals were killed and underwent histological inspection. Ectopic bone formation was observed both on three-dimensionally reconstructed CT scans and histological examination in all rats at sites treated with Ad-BMP-2. Histological analysis demonstrated bone at different stages of maturity adjacent to the spinous processes, laminae, and transverse processes.
Conclusions. Results of this study clearly demonstrated that it is possible to produce in vivo endochondral bone formation by using direct adenoviral construct injection into the paraspinal musculature, which suggests that gene therapy may be useful for spinal fusion in the future.
Simultaneous anterior—posterior approach to the thoracic and lumbar spine for the radical resection of tumors followed by reconstruction and stabilization
Authors: Fourney Daryl R. , Abi-Said Dima , Rhines Laurence D. , Walsh Garrett L. , Lang Frederick F. , McCutcheon Ian E. , Gokaslan Ziya L. 
Published: May 2009

Object. Thoracic or lumbar spine malignant tumors involving both the anterior and posterior columns represent a complex surgical problem. The authors review the results of treating patients with these lesions in whom surgery was performed via a simultaneous anterior—posterior approach.
Methods. The hospital records of 26 patients who underwent surgery via simultaneous combined approach for thoracic and lumbar spinal tumors at our institution from July 1994 to March 2000 were reviewed. Surgery was performed with the patients in the lateral decubitus position for the procedure. The technical details are reported.
The mean survival determined by Kaplan—Meier analysis was 43.4 months for the 15 patients with primary malignant tumors and 22.5 months for the 11 patients with metastatic spinal disease. At 1 month after surgery, 23 (96%) of 24 patients who complained of pain preoperatively reported improvements (p < 0.001, Wilcoxon signed-rank test), and eight (62%) of 13 patients with preoperative neurological deficits were functionally improved (p = 0.01). There were nine major complications, five minor complications, and no deaths within 30 days of surgery. Two patients (8%) later underwent surgery for recurrent tumor.
Conclusions. The simultaneous anterior—posterior approach is a safe and feasible alternative for the exposure tumors of the thoracic and lumbar spine that involve both the anterior and posterior columns. Advantages of the approach include direct visualization of adjacent neurovascular structures, the ability to achieve complete resection of lesions involving all three columns simultaneously (optimizing hemostasis), and the ability to perform excellent dorsal and ventral stabilization in one operative session.
Amyloidoma of the thoracic spine
Authors: Suri Vaishali S. , Tatke Medha , Kumar Sushil , Gupta Vikas 
Published: May 2009

✓ The authors report the case of a patient with amyloidoma of the thoracic spine. A 34-year-old man presented with a 2-month history of upper-back pain, bilateral lower-extremity weakness, and numbness below the nipple.
A computerized tomography study revealed an extradural mass with destruction of the T-2 lamina and pedicle. Intraoperatively, there was a pinkish, partially suctionable mass infiltrating the muscle plane and causing destruction of the T-2 lamina. Histological examination showed typical amyloid masses that demonstrated apple-green double refraction on examination of the Congo red—stained section under polarized light.
Amyloidomas are rare benign lesions that, unlike other forms of amyloidosis, have an excellent prognosis. A cure is possible with complete resection of the mass.
Anatomical location of T2–3 sympathetic trunk and Kuntz nerve determined by transthoracic endoscopy
Authors: Wang Yeou-Chih , Sun Ming-Hsi , Lin Chi-Wen , Chen Yen-Ju 
Published: May 2009

Object. Bilateral subaxillary transthoracic endoscopic sympathectomy (TES) is a popular procedure of upper thoracic sympathectomy. The anatomical locations of the T-2 and T-3 sympathetic trunks, as viewed under the endoscope, are varied in the rib head areas. In this study, the authors investigated the more visible anatomical locations of the T-2 and T-3 sympathetic trunks, the so-called nerves of Kuntz, and intercostal rami by performing transthoracic endoscopy.
Methods. Seventy patients with palmar hyperhidrosis undergoing bilateral TES (140 sides) via the anterior subaxillary approach were included in this study. The operative findings and video images of the T-2 and T-3 sympathetic trunks and ganglia were recorded and analyzed. The anatomical locations of the T-2 and T-3 sympathetic trunks along the horizontal axes of the rib heads were determined using a three-region system constructed by the authors. The area between the rib neck and the medial border of the rib head was equally divided into Region E (external half) and Region M (medial half). The area between the medial border of the rib head and the paravertebral ligament was defined as Region I.
The incidence of the T-2 and T-3 sympathetic trunks found in Regions E, M, and I were 31.4 to 42.9%, 50 to 57.1%, and 7.1 to 11.4%, respectively, on the left side, and 24.3 to 34.3%, 57.1 to 65.7%, and 8.6 to 10%, respectively, on the right side. One right (1.4%) and six left (8.6%) Kuntz nerves originating from the T-3 sympathetic trunk were found in seven patients (10%). The intercostal ramus was found around the T-2 rib neck in 24 patients (34.3%), with 18 cases (25.7%) for each side. The intercostal ramus around the T-3 rib neck was found in 17 patients (24.3%): 12 (17.1%) on the right and nine (12.9%) on the left.
Conclusions. These results indicate that approximately 90% of the T-2 or T-3 sympathetic trunks are located on the rib head. These findings may also be used to assist the surgeon in fluoroscopic guidance for locating the T-2 and T-3 sympathetic trunks during posterior percutaneous sympathectomy.
Anterior cervical fusion with carbon fiber cage containing coralline hydroxyapatite: preliminary observations in 45 consecutive cases of soft-disc herniation
Authors: Agrillo Umberto , Mastronardi Luciano , Puzzilli Fabrizio 
Published: May 2009

Object. The purposes of bone substitutes for anterior cervical fusion (ACF) are immediate biomechanical support and osteointegration of the graft. The authors report their preliminary results in performing ACF in which carbon fiber cages (CFCs) containing coralline hydroxyapatite (HA) are used as bone substitute.
Methods. During a 24-month period, anterior microsurgical discectomy was performed in 45 consecutive patients for soft-disc cervical herniation. In all cases ACF was performed using a CFC containing a core of granulated coralline HA. Fifty-seven CFCs were implanted in 33 single-level and 12 two-level procedures.
The mean operative time was 83 minutes for one-level and 97 minutes for two-level procedures. The mean hospital stay was 1.51 days, and there were no permanent complications. At a mean follow up of 22.3 months, the pain had decreased or disappeared in all patients, and the patients' satisfaction rate was very high. Good results were also obtained in patients who smoked cigarettes. Patients underwent radiographic evaluation at Day 1, and 1, 3, 6, and 12 months postoperatively. Implant-related complications were not observed and revision surgeries were not performed. Twelve-month cervical x-ray films demonstrated complete fusion in all cases, without evidence of breakage, collapse, pseudarthrosis, subsidence, angular deformity, or protrusion. Signs of pathological absorption and necrosis were not found in contiguous vertebral bodies, and inflammatory reactions were never seen around cages.
Conclusions. These preliminary results suggest that implants composed of CFC containing granulated coralline HA are promising bone substitutes to be used in ACF, with a good rate of incorporation and no significant complications.