bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intracranial Arteriovenous Malformations Associated with Aneurysms
Authors: Batjer Hunt , Suss Richard A. , Samson Duke 
Published: May 2010

Abstract
The presence of intracranial aneurysm in association with arteriovenous malformation has been well documented. Aneurysms have been described in typical proximal sites along the feeding system to the arteriovenous malformation, in abnormal distal locations along feeding vessels, and in sites remote and apparently hemodynamically unrelated to the arteriovenous malformation. Little attention has been focused on the most appropriate medical and surgical care of patients harboring these lesions. Since 1977, 22 patients with this combination of lesions have been evaluated at our institution. Nine patients (41%) presented after intracranial hemorrhage. The remaining 13 patients were investigated because of seizures in 5 patients (23%), headaches in 4 patients (18%), and progressive ischemia in 4 patients (18%). Among the patients suffering intracranial hemorrhage, 78% had bled from an aneurysm, with 22% having hemorrhaged from their arteriovenous malformation. All 7 of the patients who suffered aneurysmal hemorrhage bled from atypical distal aneurysms on major feeding vessels. Our experience and that of others has led us to believe that the safest approach to patients with this combination of lesions is to treat the aneurysm before microsurgical resection of the associated arteriovenous malformation. Hemodynamic changes associated with the abrupt elimination of an arteriovenous malformation may place associated aneurysms at immediate risk.
Suppression of Pain in Trigeminal Neuropathy by Electric Stimulation of the Gasserian Ganglion
Authors: Meyerson B. A. , Håkanson S. 
Published: May 2010

Abstract
Lesions of the peripheral part of the trigeminal nerve may cause trigeminal neuropathy associated with severe pain. Such pain usually does not respond to carbamazepine and analgesics, and it is continuous and lacks the characteristic paroxysmal character of tic douloureux. These patients often present with complex changes of facial sensibility in the form of dysesthesia, hyperalgesia, and allodynia. The pain sometimes responds favorably to transcutaneous nerve stimulation, but direct stimulation of the trigeminal ganglion and rootlets via an implanted electrode provides a greater likelihood of pain relief. Fourteen patients diagnosed as having painful trigeminal neuropathy received implants of a gasserian ganglion-stimulating electrode. The mean follow-up period is 4 years (range, 1 to 7 years). Eleven of the patients have retained the pain-relieving effect, and 1 had pain disappear without further stimulation. Eight of the patients estimated their pain relief to be complete or very good. There were no serious complications, but in several of the patients the electrode had to be exchanged because the insulation of the lead wires broke. For the selection of patients for permanent electrode implantation, a method has been developed for trial stimulation via a percutaneous electrode introduced into the trigeminal cistern. Temporary trial stimulation can be performed for several days. It is concluded that stimulation of the trigeminal ganglion and rootlets with the aid of an implanted electrode may effectively relieve certain forms of trigeminal pain that are otherwise extremely difficult to manage.
Posttraumatic Intracranial Meningioma: A Case Report and Review of the Literature
Authors: Barnett Gene H. , Chou Samuel M. , Bay Janet W. 
Published: May 2010

Abstract
A case of posttraumatic meningioma with pathological evidence of intimate association with a nidus of chronic inflammatory reaction is presented. The literature regarding the controversial association of trauma with this neoplasm is critically reviewed. Although meningiomas are not common sequelae of head trauma, it is proposed that they may arise when the injury results in chronic inflammation.
Giant Congenital Cellular Blue Nevus of the Scalp of a Newborn with an Underlying Skull Defect and Invasion of the Dura Mater
Authors: Spetzler Robert F. , Marano Stephen R. , Brooks Robert A. , Rekate Harold L. 
Published: May 2010

Abstract
A case of a giant congenital cellular blue nevus of the scalp of a newborn with focal areas of malignant melanoma is presented. The nevus was associated with focal invasion of the underlying soft tissues, calvarium, epidural space, and dura mater. The later appearance of pigmented nevi in the submandibular region, sternocleidomastoid muscle, and testicular hydrocele raises the question of future metastases despite the nonmalignant microscopic appearance. Therapy consisted of total excision with cranioplasty and rotation and split skin grafts after temporary closure with silicone mesh.
Subarachnoid Hemorrhage and the Heart
Authors: Marion Donald W. , Segal Ricardo , Thompson Mark E. 
Published: May 2010

Abstract
Electrocardiographic abnormalities, both morphological and rhythmic, are frequently seen in association with spontaneous subarachnoid hemorrhage. These changes, which often reflect subendocardial damage, seem to be caused by hypothalamic stimulation leading to an acute increase in sympathetic tone. As a result, potentially life-threatening ventricular arrhythmias may develop in subarachnoid hemorrhage patients. These arrhythmias have responded to sympathetic blocking agents, which may also have a protective effect on subendocardial tissue in this setting. There is no evidence that the prophylactic administration of propranolol or other autonomic blockers significantly alters outcome in these patients. Ultimate morbidity and mortality are clearly related to the degree of intracerebral-intraventricular hemorrhage and vasospasm. This article reviews experimental and clinical evidence regarding the causes of cardiac abnormalities after subarachnoid hemorrhage, the types of abnormalities most frequently seen, their relationship with subendocardial lesions, and the role of autonomic blockers.
Basilar Aneurysm Surgery: The Subtemporal Approach with Section of the Zygomatic Arch
Authors: Sergio Domingos Pitelli , Gilberto G. M. Almeida , Edison J. Nakagawa , Antonio J. T. Marchese , Nilton Domingos Cabral 
Published: May 2010

Abstract
The authors propose a modification of the classic subtemporal approach for basilar aneurysm. This modification allows excellent access to the floor of the temporal fossa, the tentorial edge, and the interpeduncular fossa with less brain retraction than is required with the original technique. The procedure is described, our experience with it is presented, and suggestions are made for its use
Neuroleptic Malignant Syndrome Complicating Closed Head Injury
Authors: Vincent Frederick M. , Zimmerman J. Eric , Van Haren James 
Published: May 2010

Abstract
Lethargy, hyperpyrexia, tremor, and rigidity associated with leukocytosis and elevation of the creatine kinase level occurred in a patient with a closed head injury who was being treated with haloperidol for control of agitation. This constellation of symptoms, known as the neuroleptic malignant syndrome (NMS), partially improved when the neuroleptic medication was stopped, but complete resolution of the syndrome did not occur until the patient was treated with bromocriptine. Because haloperidol is the most widely used medication for the agitation that develops in patients with significant closed head injuries, neurosurgeons should be aware of the NMS. The NMS is caused by neuroleptic medications and may initially present with unexplained hyperpyrexia, leukocytosis, and elevated creatine kinase levels. Halting the neuroleptic, supportive care, and the use of dantrolene sodium and bromocriptine are the treatment modalities of choice for this syndrome, which has a mortality rate of 20 to 30% and may be linked to malignant hyperthermia.
Traumatic False Aneurysms of the Middle Meningeal Artery
Authors: Flores Jorge Salazar , Vaquero Jesus , Sola Rafael Garcia , Rossi Eduardo , Martinez Roberto , Martinez Pedro , Santos Hugo , Bravo Gonzalo 
Published: May 2010

Abstract
The authors report a rare case of traumatic false aneurysm of the middle meningeal artery associated with a delayed contralateral extradural hematoma. The extradural hematoma was evacuated, and the pseudoaneurysm was removed to avoid delayed rupture. The literature on traumatic aneurysms is reviewed.
Variant Aneurysms of the Fenestrated Basilar Artery
Authors: Andrews Brian T. , Michael Brant-Zawadzki , Wilson Charles B. 
Published: May 2010

Abstract
Two cases of aneurysm occurring on a fenestrated basilar artery are reported. One patient had a saccular aneurysm in the typical location at the vertebrobasilar junction at the proximal end of the fenestrated basilar segment. The aneurysm sac projected dorsally into the brain stem. The other patient had a blister-like aneurysm distal to a fenestration of the terminal basilar artery. The development of a distal aneurysm on a fenestrated basilar artery is predictable based on the reported morphology of the vessel wall in this vascular anomaly.
Case Report: Subarachnoid Hemorrhage Due to Anterior Spinal Artery Aneurysm
Authors: Smith Bryson S. , Penka Christopher F. , Erickson LaVerne S. , Matsuo Fumisuke 
Published: May 2010

Abstract
This case report describes a 29-year-old man with subarachnoid hemorrhage due to an anterior spinal artery aneurysm. Surgical obliteration of the aneurysm was successful. This is the sixth reported case of an isolated symptomatic aneurysm of a spinal artery.
Potential Roles for Early Revascularization in Patients with Acute Cerebral Ischemia
Authors: Batjer Hunt , Mickey Bruce , Samson Duke 
Published: May 2010

Abstract
The risk of carotid endarterectomy in acute cerebral ischemic situations is well documented. By using the superficial temporal or occipital artery, it is possible to provide relatively low flow revascularization conduits, potentially avoiding the risk of postoperative hemorrhage. Eighteen patients at The University of Texas Health Science Center at Dallas, Texas, have been treated recently with extracranial to intracranial bypass in the setting of acute neurological deficit, stroke in evolution, or recent completed infarction. Angiographic causes of these deficits included cervical carotid occlusion in 5 patients, carotid siphon disease in 2 patients, middle cerebral stenosis or occlusion in 3 patients, and delayed cerebral ischemia following subarachnoid hemorrhage in 8 patients. Neurological improvement was demonstrated within 24 hours following revascularization in 15 cases (83%); 3 patients were unchanged following bypass, and no patient's condition was worsened. The only case of postoperative intracerebral hemorrhage occurred 1 week following a long saphenous vein graft from the subclavian to the middle cerebral artery. After an average follow-up of 19 months, 7 patients are neurologically normal, 8 patients have mild to moderate deficits, and 3 patients have died. Low flow revascularization procedures appear to be safe in the setting of acute cerebral ischemia and may in selected patients boost regional cerebral blood flow from levels of symptomatic ischemia into a range compatible with normal neuronal function. (Neurosurgery 18:283-291, 1986)
Occipital Lobe Infarction Caused by Tentorial Herniation
Authors: Sato Masaharu , Tanaka Shigeru , Kohama Akitsugu , Fujii Chiiho 
Published: May 2010

Abstract
Occipital lobe infarction caused by tentorial herniation was described based on computed tomography findings in nine patients. The whole area of the occipital lobe was involved in five patients; some areas were spared in the others. Infarction other than the ipsilateral occipital lobe was seen in four areas of nine patients: the ispsilateral posterior limb of the internal capsule, contralateral Ammon's horn, and two contralateral occipital lobes. Hemorrhagic infarction was seen in two patients.
Experience in the Management of Odontoid Process Injuries: An Analysis of 128 Cases
Authors: Dunn Mary Elizabeth , Seljeskog Edward L. 
Published: May 2010

Abstract
The authors present a retrospective analysis of 128 cases of odontoid process injury treated at the University of Minnesota and affiliated hospitals between the years 1967 and 1983. Of these 128 cases, 110 were acute fractures, while 18 patients suffered from old, unstable odontoid injuries. Motor vehicle accident was the leading cause of injury, and the largest group of patients was in their second decade. Type II fractures were the most commonly encountered type of injury, and anterior subluxation was the most common displacement. Posterior subluxation, however, had the highest incidence of associated neurological deficit. Regarding treatment, the 110 acute fracture patients fell into the following groups: 16 patients died during the acute phase, 14 patients underwent early posterior cervical fusion, and 80 patients underwent a course of external skeletal fixation. The remaining 18 patients with old unstable injuries underwent posterior cervical fusion. An analysis of the results in these groups led to the elucidation of certain factors that likely are important in determining the treatment of each individual patient. These factors include age of the patient, type of odontoid fracture, direction and degree of fracture displacement, and diagnostic delay. Fracture reduction and halo immobilization are the treatments preferred for patients who are diagnosed within 1 week of injury, who are less than 65 years of age and who have anteriorly, nondisplaced, or minimally posteriorly subluxed (&lt;2 mm) Type II fractures, or who have any Type III injury. In contrast, posterior cervical fusion should be considered seriously in those patients over 65 years of age with Type II fractures or with posterior subluxations greater than 3 mm, in patients with diagnosis later than 7 days after injury, and especially in patients who have suffered redislocation while undergoing a closed form of management.
Cervical Spine Fractures with Major Associated Trauma
Authors: Reiss Steven J. , Raque George H. , Shields Christopher B. , Garretson Henry D. 
Published: May 2010

Abstract
A detailed review of 88 consecutive patients placed in skeletal tong traction for cervical fractures by the University of Louisville Neurosurgical Service during a 5-year period from July 1, 1979, through June 30, 1984, was carried out. Of this group, 60% of the patients had a major associated injury consiting of major facial and skull fractures, cerebral contusions or intracerebral blood clots, cardiac or pulmonary contusions, major thoracic injuries including rib fractures and hemo- or pneumothoraces, intra-abdominal injuries, and major extremity fractures. An additional 24% of the patients had minor associated injuries, including facial or scalp lacerations, general body lacerations, or abrasions and cerebral concussions. Only 16% of patients with cervical fractures had no evidence of any other associated injury. Acute cervical spine fractures require prompt assessment and resuscitation by personnel from multiple specialties, usually available only in major trauma centers where experienced personnel capable of handling diverse injuries are always present.
Percutaneous Placement of Ventriculoatrial Shunts: Four-Year Case Experience
Authors: Carol Mark , Robinson Walker , Harris Bruce S. 
Published: May 2010

Abstract
During the past 4 years, we have used percutaneous placement of the atrial catheter in 39 patients who have undergone ventriculoatrial shunting. The age range of our patients has been from 9 to 74 years of age, with routine indications existing. Both subclavian and internal jugular venous access have been utilized, with the latter being our preferred route of access for reasons of safety. Average operative time has been approximately 35 to 40 minutes. Both traditional and split-sheath introducer catheters have been used. Patient follow-up has been up to 4 years. Intraoperative complications have been limited to puncture of the carotid artery on two occasions; neither affected the ultimate performance of the procedure. Postoperative complications have been limited to those peculiar to shunt procedures in general and have required revision in four instances. One patient suffered an infection secondary to shunting. The benefits of this procedure seem to include safety, decreased operative site exposure, and decreased operative time, all factors that may contribute to a lower than normal infection rate and may warrant consideration of this procedure in adolescents and adults for whom ventriculoatrial shunting is indicated.
Syringomyelia and Syringobulbia Associated with an Ependymoma of the Cauda Equina Involving the Conus Medullaris: Case Report
Authors: Nagahiro Shinji , Matsukado Yasuhiko , Kuratsu Jun-ichi , Saito Yoshiki , Takamura Seishi 
Published: May 2010

Abstract
A patient with syringomyelia and syringobulbia secondary to an asymptomatic ependymoma of the cauda equina involving the conus medullaris is described. Delayed metrizamide computed tomography myelography was decisive for making the diagnosis of a highly extended syrinx associated with the tumor. Syringomyelic symptoms improved remarkably following the removal of the tumor, and the syrinx was not visualized in a postoperative study. The pathogenesis of syringomyelia associated with a caudally located spinal cord tumor is discussed.
Primary Leptomeningeal Gliomatosis and “Numb, Clumsy Hands”: A Case Report
Authors: Blumenkopf Bennett , Gutierrez Jorge , Bennett William 
Published: May 2010

Abstract
A 48-year-old man presented with the numb, clumsy hand syndrome. Evaluation revealed a high cervical cord lesion. Surgical exploration discovered leptomeningeal gliomatosis with no discernible intraparenchymal component. The clinical features of the case, the neuroimaging studies including magnetic resonance scanning, and the most unusual pathological nature of the lesion are discussed.
Orbitocraniobasal Approach for Anterior Communicating Artery Aneurysms
Authors: Fujitsu Kazuhiko , Kuwabara Takeo 
Published: May 2010

Abstract
We describe an orbitofrontotemporobasal craniotomy technique that allows excellent access to anterior communicating artery aneurysms. This orbitocraniobasal approach is particularly useful for the surgical treatment of ruptured aneurysms in the acute stage of subarachnoid hemorrhage, when retraction of the brain needs to be kept to a minimum. With this approach, retraction of the orbital contents decreases the amount of retraction of the brain to such an extent that a brain spatula is not necessary for access to the anterior communicating artery complex. The procedure is described, as is a modification of the approach for removal of large tumors on the skull base.
Pyogenic Abscess of the Medulla Oblongata
Authors: Dake Michael D. , McMurdo Keith S. , Rosenblum Mdark L. , Brant-Zawadzki Michael 
Published: May 2010

Abstract
Pyogenic brain stem abscess is rare. A case of spontaneous abscess of the medulla oblongata is reported in which the diagnosis was made preoperatively by computed tomography. Surgical drainage resulted in good functional recovery and radiological resolution of the lesion. This is the first reported case of survival in a patient with an abscess of the medulla oblongata. The pathophysiology, clinical symptoms, and radiological appearance of the entity are discussed. Prompt diagnosis and drainage are emphasized as important factors influencing survival.
Ventriculoatrial Shunt Infection Due to Cryptococcus neoformans: An Ultrastructural and Quantitative Microbiological Study
Authors: Walsh Thomas J. , Schlegel Robert , Moody Marcia M. , Costerton John W. , Salcman Michael 
Published: May 2010

Abstract
A 28-year-old man presented with hydrocephalus due to an infection by Cryptococcus neoformans involving his ventriculoatrial shunt. Ultrastructural studies of the ventriculoatrial shunt demonstrated yeastlike organisms consistent with C. neoformans within a biofilm on the appliance. Quantitative microbiological studies of segments of the shunt demonstrated C. neoformans in a concentration gradient from 9 × 106 colony-forming units (CFU)/0.5-cm section involving the ventricular portion of the catheter to 1 × 102 CFU/0.5-cm section at the vascular tip. The clinical, microbiological, and ultrastructural data suggest that this cryptococcal infection started as a ventriculitis or encephalitis with extension to the meningeal surface. Future application of these methods may further elucidate the pathogenesis of ventriculoatrial shunt infections.
Progressive Multifocal Leukoencephalopathy: Three Patients Diagnosed by Brain Biopsy, with Prolonged Survival in Two
Authors: Schlitt Michael , Morawetz Richard B. , Bonnin Jose , Chandra-Sekar B. , Curtiss John J. , Diethelm Arnold G. , Whelchel John D. , Whitley Richard J. 
Published: May 2010

Abstract
Since 1980, three immunocompromised patients have been proved to have progressive multifocal leukoencephalopathy (PML) by brain biopsy at the University of Alabama at Birmingham. Two patients presented with focal neurological findings, and the third presented with dementia. Computed tomography (CT) revealed white matter low density lesions in areas appropriate to the neurological abnormalities. Brain biopsy of areas that were abnormal on CT produced diagnostic tissue in all three patients. No patient suffered ill effects from the biopsy. Neuropathological findings on light microscopy were compatible with PML in each case, although there was diversity within the group. Involvement of gray and white matter was present in all biopsy specimens; oligodendrocytes, astrocytes, and neurons were affected. Electron microscopic demonstration of particles compatible with polyoma virus confirmed the diagnosis in each case. Immunosuppressive medication was discontinued in two of the patients; these two have survived more than 2 years after diagnosis. One of these two has gradually improved and is independent in simple activities of daily life. Brain stem and cerebellar involvement and seizure disorders have been present in all reported cases. PML can be accurately and rapidly diagnosed by brain biopsy, enabling therapeutic manipulations that may prolong survival.
Experience with External Pneumatic Calf Compression in Neurology and Neurosurgery
Authors: Black Peter McL. , Baker Mary F. , Snook Curtis P. 
Published: May 2010

Abstract
This report reviews our experience with external pneumatic compression (EPC) therapy in preventing clinically evident deep venous thrombosis (DVT) and pulmonary emboli (PE) in neurological and neurosurgical patients. A total of 523 patients admitted to the Departments of Neurology and Neurosurgery at the Massachusetts General Hospital from December 1980 through January 1984 are included. The incidence of DVT despite EPC use was 2.3%. The incidence of PE diagnosed by lung scan and usually confirmed by angiography was 1.8%. In conjunction with previously published reports of the incidence of DVT and PE, these data suggest that EPC may be efficacious in decreasing the incidence of DVT but may not prevent PE in neurological and neurosurgical patients.
Spontaneous Arteriovenous Fistulas of Cerebral Vessels in Association with Fibromuscular Dysplasia
Authors: Hieshima Grant B. , Cahan Leslie D. , Mehringer Mark C. , Bentson John R. 
Published: May 2010

Abstract
Four cases of spontaneous arteriovenous fistula seen in association with fibromuscular dysplasia of the parent artery are presented. In two patients, the fistula was between the carotid artery and cavernous sinus; in two others, the fistula involved the vertebral artery and paravertebral veins. It is postulated that the angiopathy was responsible for the fistula. Treatment by detachable balloon embolization was successful in each case; however, the presence of the fibromuscular dysplasia made treatment more difficult.