bluuebunny/crossref_metadata_2025_split huggingface dataset:
Regional cerebral blood flow, sensory evoked potentials, and intracranial pressure in dogs with MCA occlusion by embolization or trapping
Authors: Okada Yoshikazu , Shima Takeshi , Yamamoto Mitsuo , Uozumi Tohru 
Published: May 2009

✓ Regional cerebral blood flow (rCBF), sensory evoked potentials (SEP), and intracranial pressure (ICP) were investigated in dogs with focal cerebral ischemia produced by a silicone cylinder embolus in the middle cerebral artery (MCA) trunk as compared to that produced by trapping the same vessel. These variables were measured at intervals of 1 hour for a period of 6 hours after MCA occlusion.
In the embolized animals, rCBF decreased most extensively at the basal ganglia, from a control level of 53.9 ± 3.9 (mean ± SE) to 21.5 ± 2.7 ml/100 gm/min at the 6th hour. Sensory evoked potentials decreased progressively from the resting level of 100% to 53.0% ± 7.2% at the 3rd hour. Intracranial pressure, measured by epidural pressure on the occluded side, increased rapidly during the first 3 hours, from 10.6 ± 0.3 to about 30 cm H2O.
In the animals with trapping, the decreases in rCBF and declines of SEP were significantly less than those in the embolized animals, and no evident brain swelling was observed. This study demonstrates that MCA trunk occlusion by silicone cylinder embolization produces a more marked decrease in deep CBF, with diminution of SEP and increase in ICP, than that produced by trapping.
Meningeal malignant fibrous histiocytoma arising from a thoracolumbar myelomeningocele
Authors: Helle Todd L. , Hanbery John W. , Becker Dennis H. 
Published: May 2009

✓ The authors present a case of malignant fibrous histiocytoma (MFH) involving a thoracolumbar myelomeningocele. The patient died of metastases 11 months after diagnosis, in spite of extensive surgery, radiation therapy, and chemotherapy. Meningeal involvement by MFH is very rare; 11 additional cases are reviewed. Glial fibrillary acidic protein staining is critical for proper histological diagnosis, as this tumor can be easily confused with pleomorphic xanthoastrocytoma or glioblastoma involving the meninges.
Malignant degeneration within a myelomeningocele is also very rare. Eight additional cases from the literature are reviewed. Our case is the only one with MFH. Chronic irritation to the unrepaired congenital defect appears to be a key to the development of the malignancy. Prophylactic repair in infancy might prevent the occurrence of malignant degeneration.
Diagnosis and management of pineal tumors
Authors: Jooma Rashid , Kendall Brian E. 
Published: May 2009

✓ The management of pineal region tumors remains controversial. Advocates of a conservative approach emphasize the excellent results of radiotherapy, particularly with germinomas, while a number of recent reports have demonstrated the safety of direct surgery. In order to improve treatment planning, attempts have been made to distinguish the various tumor types by computerized tomography (CT) and by the use of markers for germ-cell tumors. This paper reports a study of 35 patients with pineal tumors including two ectopic germinomas. Pretreatment CT was performed in all 35 patients, and human chorionic gonadotropin and alpha-fetoprotein levels were assayed in 11. Histological verification was available for 33 tumors; the other two were characterized by clinical and CT features plus tumor markers. Of the 27 tumor operations, 21 were for a pineal mass and six for ectopic germinoma or metastasis. There was no operative mortality. Morbidity was minimal, and surgery did not increase the incidence of subarachnoid seeding.
Each histological type of tumor has a typical appearance on CT scanning, although, in the individual case, a firm diagnosis is not always possible. However, consideration of CT scans together with the clinical features, cerebrospinal fluid cytology, tumor markers, and (if there is still doubt) response to a small dose of irradiation will generally allow a specific diagnosis with a high degree of probability. In this way, germinomas may be selected for radiotherapy and the tumors less likely to respond may be subjected to primary surgery.
Phenytoin and postoperative epilepsy
Authors: North J. Brian , Penhall Robert K. , Hanieh Ahmad , Frewin Derek B. , Taylor William B. 
Published: May 2009

✓ A double-blind trial of phenytoin therapy following craniotomy was performed to test the hypothesis that phenytoin is effective in reducing postoperative epilepsy. A significant reduction in the frequency of epilepsy was observed in the group receiving the active drug up to the 10th postoperative week. Half of the seizures occurred in the first 2 weeks and two-thirds within 1 month of cranial surgery. High rates of epilepsy were observed after surgery in patients with meningioma, metastasis, aneurysm, and head injury.
Routine prophylaxis with phenytoin (in a dosage of 5 to 6 mg/kg/day) would seem to be indicated, particularly in high-risk patients and, where possible, this treatment should be started 1 week preoperatively. Seizure control is best when therapeutic levels of phenytoin are maintained.
Rehabilitation of the neurologically disabled patient: principles, practice, and scientific basis
Authors: Perry Jacquelin 
Published: May 2009

✓ Rehabilitation is a therapeutic program specifically directed toward restoring the optimum level of function available to patients with severe permanent disabilities. It complements standard care, which focuses on curing the primary pathology. Preventive rehabilitation is designed to minimize the complications of inactivity that tend to develop during a protracted curative process (contractures, pressure sores, muscle atrophy, cardiopulmonary deconditioning, cognitive dulling). Comprehensive rehabilitation focuses on the restoration of function. It encompasses physical reconditioning, teaching new ways to accomplish the basic tasks of locomotion, object handling, personal care, relationships with family and society, employment, and recreation. The rehabilitation program is largely designed and provided by a team of allied health professionals, each an expert in one area of function. Reverting to a less dominant role, the physician provides leadership by defining the stress (activity) tolerance of the patient's pathology, coordinates the team, and manages intercurrent problems that arise. Comprehensive rehabilitation is an in-hospital program. Less intense elements can be provided in a skilled nursing facility, out-patient clinic, or the patient's home.
The details of the rehabilitation process vary with the nature of the patient's primary pathology. These have been illustrated in this review of the programs for two very diverse situations. Spinal cord injury introduces varying levels of physical incapacitation. Conversely, brain injury primarily creates a cognitive and behavioral deficit. Both are complex problems requiring comprehensive rehabilitation if the impairment is severe.
Ruptured cerebral aneurysms: early and late prognosis with surgical treatment
Authors: Shephard Reginald H. 
Published: May 2009

✓ An account is given of a personal prospective series of 815 patients with the syndrome of spontaneous subarachnoid hemorrhage (SAH) due to ruptured cerebral aneurysm. It concerns all aneurysm patients at risk, both surgical and nonsurgical cases, referred to the author during two main periods: 606 patients were treated during the earlier period of 15 years, and 209 in the subsequent 7 years.
The early mortality rate was determined at 3 months, and all survivors in the first period were followed for a mean of 9 years. Only operation survivors were observed during the second period, for 3 years on average. Patients alive at 3 months were studied in detail with respect to disabilities, work capacity, and later mortality.
Of the 815 patients, 613, or 75%, were operated on. Comment is made on the influence of certain factors on early mortality. These include age, hypertension, condition of the patient at admission, and number of hemorrhages. From the results of this series, it is suggested that the preferable time to operate is between the 2nd and the 4th day after a single SAH. In this period, the early mortality rate is in the order of 10%. In this subgroup, a high proportion of the patients were in Botterell Grades 1 and 2, with only a few being in Grade 3. Also evident from the results was the protective value of operation against further aneurysm rupture in the 501 patients surviving at 3 months. However, the propensity of a second aneurysm to rupture in patients with multiple aneurysms has resulted recently in a change of operation policy.
The early mortality in the whole series and later mortality in patients surviving 3 months is shown in tabular and histogram form. From these, it is clear the majority of later deaths are from causes unrelated to aneurysm rupture.
Transsphenoidal microsurgical management of Cushing's disease
Authors: Boggan James E. , Tyrrell J. Blake , Wilson Charles B. 
Published: May 2009

✓ The development of transsphenoidal microsurgery and the refinement of endocrinological and radiological diagnostic procedures have afforded therapeutic options appropriate to the individual case in patients with hypercortisolism. The present series of 100 cases is derived from 104 patients with the diagnosis of Cushing's disease who underwent transsphenoidal pituitary exploration between 1974 and 1981. Excluding four patients in whom the pituitary gland was not exposed because of intraoperative technical difficulties, an overall cure rate of 78% was achieved. Among 71 patients with tumors confined to the sella turcica, 87% had correction of their hypercortisolism, 11% represented therapeutic failures, and one patient had tumor recurrence. In contrast, among 25 patients with extrasellar extension, correction of hypercortisolism was achieved in only 48%, 40% failed to respond, and 12% of the patients had recurrence. Four patients who failed to respond to total hypophysectomy have ectopic sources of adenocorticotropic hormone.
The results indicate that transsphenoidal microsurgical exploration for a basophilic adenoma is the procedure of choice in adults and children with Cushing's disease. The diagnostic and surgical approach to these tumors, as well as pitfalls in the transsphenoidal treatment of Cushing's disease, are discussed.
The National Traumatic Coma Data Bank
Authors: Marshall Lawrence F. , Toole Belinda M. , Bowers Sharon A. 
Published: May 2009

✓ The records of the first 325 patients entered into the pilot phase of the National Traumatic Coma Data Bank were reviewed. Thirty-four severely head-injured patients who talked prior to deteriorating to a Glasgow Coma Scale (GCS) score of 8 or less were identified. Of those 34 patients, 18 died or were left vegetative and 16 recovered. While there were certain common factors between those who talked and died and those who talked and recovered, there were also significant differences. The common factors between the two groups were the length of time to deterioration or operative intervention (16 versus 18 hours, respectively), and the initial GCS scores (12.6 versus 12.4, respectively).
The primary differences between the groups included the mean age, the degree of midline shift seen on computerized tomography (CT), and the presence of subdural hematoma. Those who talked at some point postinjury, but who subsequently died, had a mean age of 50 years. Those who talked, deteriorated, and then recovered were found to have a mean age of 32 years. Seven of the 18 patients who talked and died had a shift of greater than 15 mm on CT, while this degree of shift was demonstrated in only one of 16 patients who talked, deteriorated, and recovered.
Subdural hematomas were significantly more common in the “talk and die” group, as was the overall need for operation. Since the overwhelming majority of patients with marked shift on CT have surgical lesions, early operative intervention is strongly recommended in these patients, prior to their inevitable deterioration.
Bicompartmental analysis of cerebrospinal fluid circulation
Authors: Cabanes Jerónimo , Marti José , Orozco Miguel , Beltran Andrés 
Published: May 2009

✓ A new model for cerebrospinal fluid (CSF) circulation is proposed. Specific activity/time curves for CSF kinetics determined after intraventricular injection of a radiotracer were produced by fitting a biexponential function to data points and developing a two-compartmental model. Calculation of kinetic parameters of the model provides quantitative data about CSF dynamics. The study of each compartment separately and of the intercompartmental relationship is possible with this model. Sequential scan images and graphic plots of the variations of radioactivity in both compartments, derived from this model, add supplementary information in the evaluation of patients.
Ventriculography was performed in 80 patients, who fell into four groups: those with normal CSF circulation, hydrocephalus, infantile hydrocephalus, and functioning ventricular shunts. Normal and hydrocephalic patients showed significant differences between the two groups in the means of some numerical parameters calculated from the new model. An increase of intraventricular radioactivity at 24 hours (p < 10−4) and of the volume of Compartment 1 (p < 0.01) with decreased volume of Compartment 2 (p < 10−4) and total flow outside the system (p < 10−3) were found in patients with hydrocephalus. The limiting values for normal patients were also estimated. Communicating and obstructive hydrocephalus could be differentiated by this method; however, no differences in mean values were found relating to the etiology or clinical course of the hydrocephalus. Normal-pressure hydrocephalus and cerebral atrophy produced significantly different mean values for the volume of Compartment 2 (p < 0.01), flow out of the system (p < 0.01), and intercompartmental flow (p < 0.01).
Cerebral circulation after head injury
Authors: Overgaard Jørn , Tweed William A. 
Published: May 2009

✓ A considerable body of evidence suggests that posttraumatic disturbances of the cerebral circulation contribute to poor neurological outcome after blunt head injury, especially when regional cerebral blood flow (rCBF) falls to the ischemic range (below 17 ml/100 gm/min). Cerebral infarction concentrated in the arterial boundary regions has been described in patients who died. Since arterial boundary zones are the cortical areas most susceptible to cerebral ischemia, the authors have investigated the relationship between neurological outcome and the anatomic pattern of rCBF values in the acute phase. The bolus-injection xenon-133 washout technique was used to measure rCBF in 35 regions of the hemisphere during the 1st week after head injury. Eighty-eight hemispheres were studied in 80 patients whose Glasgow Coma Scale (GCS) score was less than 8 on admission to the neurosurgical department.
A characteristic pattern of rCBF was found in patients who later died of neurological complications, or who survived in a persistent vegetative state, with low flows in regions conforming to the arterial boundary zones. These patients also had lower average global cerebral blood flow (CBF), GCS scores, and cerebral perfusion pressure compared with those who recovered, with or without neurological deficits; the latter group had an rCBF pattern similar to that of normal individuals.
There was little change in the GCS score between the time of hospital admission and CBF measurement, suggesting that the major neurological injury had occurred prior to admission. It was not possible to determine whether boundary-zone ischemia preceded neurological deterioration, but the rCBF pattern of boundary-zone flow deprivation was clearly related to poor neurological outcome. These observations suggest that elevated intracranial pressure and arterial hypotension were important etiological factors. Measures to protect regional cerebral perfusion should be instituted as early as possible after injury, preferably before the patient reaches the hospital.
Experimental investigation on the spinal cord evoked injury potential
Authors: Schramm Johannes , Krause Rolf , Shigeno Taku , Brock Mario 
Published: May 2009

✓ Averaged somatosensory evoked potentials from the epidural space in response to sciatic nerve stimulation were recorded in bipolar and common reference mode in cats following various types of injury. An investigation was conducted on the development and properties of the spinal evoked response recorded from the center of the injury site, designated here as the “spinal cord evoked injury potential.” Typically it is a two-peak monophasic positive potential, approximately 40 msec in duration, with a slight negative afterwave. With increasing distance from the site of injury, its amplitude rapidly decreases, whereas latency remains constant. The common reference recording technique resulted in an earlier and better demonstration of the evoked injury potential, especially when it was transitory or incomplete. When impairment of conduction developed gradually, the evoked injury potential developed gradually too. In serial recordings along the spinal cord axis, the transition from a normal triphasic to a monophasic evoked injury potential allowed a precise localization of the lesion.
These data suggest that the diagnostic value of intraoperative spinal cord monitoring may be increased by adopting a technique that incorporates several epidural recordings with a common reference recording technique. The spinal cord evoked injury potential seems to be a more sensitive indicator of spinal cord injury than the cortical evoked potential. The findings are discussed in the light of the presently developing spinal cord monitoring techniques.
Improved survival in cases of intracranial ependymoma after radiation therapy
Authors: Salazar Omar M. , Castro-Vita Hernan , VanHoutte Paul , Rubin Philip , Aygun Cengiz 
Published: May 2009

✓ A publication from the University of Rochester Cancer Center in 1975 suggested an improvement in the survival time of patients with intracranial ependymomas in whom an aggressive postoperative radiation therapy approach had been adopted. The regimen was tailored to the aggressiveness and spread patterns of these tumors and therefore considered the patient's age, tumor histopathology and location, and status of the subarachnoid space and cerebrospinal fluid (CSF). The authors proposed using whole brain (WB) fields for all patients with low-grade supratentorial tumors, and WB with cervical cord field extensions for low-grade infratentorial tumors if either group had no CSF or subarachnoid evidence of spinal metastases. They also proposed using craniospinal irradiation for all patients with high-grade ependymomas (regardless of location) or with low-grade infratentorial tumors with positive CSF or subarachnoid findings of spinal metastases. Recommended doses were as follows: 4500 rads to the whole brain, 5500 rads to the primary tumor volume, and 3000 to 4000 rads to the spine, depending on its subarachnoid status. Children aged 3 years or under were to receive 80% of these doses and more protracted daily treatments.
Analysis of the updated experience indicates that in 51 patients treated with this approach these criteria have yielded a beneficial and consistent increase in the survival time. A 69% 10-year survival rate has been observed (75% for low-grade and 67% for high-grade ependymomas). A multifactorial analysis of survival by prognostic factors and by grouping of prognostic factors, analysis of failures, autopsy findings, and quality of survival is presented and discussed.
The influence of systemic arterial pressure and intracranial pressure on the development of cerebral vasogenic edema
Authors: Durward Quentin J. , Maestro Rolando F. Del , Amacher A. Loren , Farrar J. Keith 
Published: May 2009

✓ The influence of intracranial pressure (ICP), systemic arterial pressure (SAP), and cerebral perfusion pressure (CPP) upon the development of vasogenic cerebral edema is largely unknown. To study their relationship, the authors have produced an osmotic disruption of the blood-brain barrier unilaterally in rabbits by injecting 1 cc/kg of 2M NaCl into the left internal carotid artery. The amount of vasogenic edema produced was assessed by quantitation of the extravasation of Evans blue dye into the area of maximum blood-brain barrier breakdown by means of optical densitometry following formamide extraction. The ICP was measured using a cisterna magna catheter into which mock cerebrospinal fluid could be infused at a predetermined pressure. The SAP was controlled by exsanguination from a femoral artery catheter.
In 18 animals in which blood pressure was not controlled, no significant relationship between the ICP and the degree of Evans blue dye extravasation was noted. In these animals, however, a direct relationship between CPP (defined as mean arterial pressure minus mean ICP) and extravasation of Evans blue dye was found (correlation coefficient 0.630; p < 0.001). When ICP was held constant at 0 to 5 mm Hg in another group of 16 animals and different levels of blood pressure were produced by exsanguination, a significant direct relationship between extravasation of Evans blue dye and the SAP was found (correlation coefficient 0.786; p < 0.001). In a third group of 20 animals, the blood pressure was held constant at 90 to 100 mm Hg and the ICP was varied between 0 and 75 mm Hg. There was a highly significant result indicating increasing Evans blue dye extravasation with lower levels of ICP (p < 0.001). Cerebral blood flow determinations by the hydrogen clearance method indicated loss of autoregulation in all animals in the areas of brain injured by intracarotid hypertonic saline.
These results indicate that high SAP and low ICP (that is, a large CPP) promote Evans blue dye extravasation in this model of blood-brain barrier disruption. This finding has implications for the management of patients with vasogenic edema.
Successful treatment of a group of spinal cord arteriovenous malformations by interruption of dural fistula
Authors: Oldfield Edward H. , Di Chiro Giovanni , Quindlen Eugene A. , Rieth Kenneth G. , Doppman John L. 
Published: May 2009

✓ As demonstrated by selective spinal cord arteriography, over 80% of spinal cord arteriovenous malformations (AVM's) occupy a predominantly extramedullary position. Current therapy frequently requires surgical stripping of the long dorsal intradural vessel(s) from the underlying spinal cord over many cord segments. The authors report six patients with a dural arteriovenous fistula fed by a cluster of abnormal epidural arteries. These vessels, which surrounded and were embedded into the dural covering of a thoracic nerve root, drained into a long sinuous intrathecal paramedullary vein(s). The angiographic and surgical appearance of the intradural component of these lesions was identical to that of lesions previously classified as Type I AVM's of the spinal cord. All patients had symptoms and signs of myelopathy. In five patients, surgery was limited to coagulation and excision of the extradural vessels and division of the intradural arterialized vein. Progressive improvement began within days following surgery. No residual abnormality was demonstrated by postoperative selective spinal cord arteriography, which was performed in all five patients.
The findings support those of Kendall and Logue, that surgery restricted to elimination of the arteriovenous fistula at the intervertebral foramen is curative, and that more extensive surgery is unnecessary for this subgroup of AVM's of the spinal cord. These lesions comprise a sizable percent of all spinal AVM's. Resolution of myelopathy in these patients supports the hypothesis that venous hypertension causes chronic progressive myelopathy.