bluuebunny/crossref_metadata_2025_split huggingface dataset:
Deafferentation Pain after Posterior Rhizotomy, Trauma to a Limb, and Herpes Zoster
Authors: Sweet William H. 
Published: August 2004

Abstract

After incisional or alcoholic destruction of trigeminal posterior rootlets, constant dysesthesias of major degree referred to some part of the markedly denervated zone develop in 5 to 15% of the patients. The full severity may not appear for weeks or months. There is no allodynia or hyperpathia of the denervated zone. Bulbar trigeminal tractotomy with sparing of touch sensation produces severe dysesthesias in a tiny percentage of the patients, as does selective destruction of pain fibers by radiofrequency heating or glycerol. Spinal posterior rhizotomy elicits in less than 4% a lasting dysesthesia entirely different in temporal sequence, locus, and type of pain: (a) it tends to be maximal early after operation and to improve, (b) the spontaneous pain is accompanied by severe allodynia, and (c) the pain is usually referred beyond the margins of the insentient (rhizotomized) zone and may even be referred to the corresponding area on the opposite side. Sindou's “selective posterior rhizotomy,” i.e., cutting of the small fiber lateral component of each rootlet as it enters the cord, has not given rise to dysesthesias. These do occur briefly in 50% of the cases following spinal ganglionectomy, the sensations being referred to the dermatomal segment of the ganglion in question. The secondary afferent neurons in the mesencephalic, principal, oral, and interpolar nuclei for the trigeminal posterior roots have no counterpart in the spinal cord for the spinal posterior roots. We suggest that the explanation for the fact that neither trigeminal neuralgia nor trigeminal anesthesia dolorosa have a spinal clinical counterpart is related to the as yet unexplained special functions of the elaborate trigeminal secondary afferent neuronal apparatus. Causalgia and sympathetic dystrophy share the fact of relief by sympathetic blockade, although only the former is associated with a sensory deficit. We conclude that the extent and nature of neural and other tissue damage are more important determinants of persistent pain than the fact of some denervation.
Current Status of the DREZ Operation: 1984
Authors: Nashold Blaine S. 
Published: August 2004

Abstract

The DREZ operation was introduced in 1976 as a method to control deafferentation pain associated with brachial plexus injury. Since then, 250 DREZ operations have been done at Duke Medical Center. At present, the best results of pain relief occur in brachial and lumbosacral root avulsions, paraplegia, and postherpetic pain. Post-DREZ complications have been reduced by the introduction of new lesion techniques, including the recent use of the laser. The neural basis of deafferentation pain is still not solved, nor is the therapeutic effect of the DREZ lesion known.
Theoretical Aspects of Radiofrequency Lesions in the Dorsal Root Entry Zone
Authors: Cosman Eric R. , Nashold Blaine S. , Ovelman-Levitt Janice 
Published: August 2004

Abstract

The history and physical principles of radiofrequency (rf) lesion making are reviewed. The advantages of the rf lesion method are presented, with emphasis on its importance in small, critical regions such as the dorsal root entry zone (DREZ). The evolution and specifications of a satisfactory DREZ rf electrode are described. DREZ lesion sizes for this electrode at specific electrode tip temperatures were experimentally determined in animals and were used as a guide to determine acceptable clinical lesioning parameters. Emphasis is placed on lesion temperature monitoring and on the stability of electrode penetration into the spinal cord to achieve consistent and safe results.
Thermocoagulation of the Dorsal Root Entry Zone for the Treatment of Intractable Pain
Authors: Samii Madjid , Moringlane Jean Richard 
Published: August 2004

Abstract

The authors report the results of DREZ thermocoagulation in 35 patients since March 1980. This technique was applied not only in patients with deafferentation pain after brachial plexus avulsion, but also for postamputation phantom limb pain and pain caused by injury to the spine and spinal cord, by peripheral nerve lesions, and by multiple sclerosis. Independent of etiology, the duration of the pain syndrome, and the quality and projection of the pain, the overall results have been satisfactory and long-lasting.
Dorsal Root Entry Zone Lesions for the Control of Deafferentation Pain: Experiences in Ten Patients
Authors: Richter Hans-Peter , Seitz Klaus 
Published: August 2004

Abstract

Experiences with radiofrequency lesions of the dorsal root entry zone in 10 patients are reported. All of these patients suffered from central (deafferentation) pain. The early postoperative results were poor in the 2 patients with traumatic paraplegia and good in all 8 patients with pain in the cervical segments. Two patients treated with cervical DREZ lesions died. In 2 of the remaining 6 patients with cervical lesions, pain recurred. Four had a good result up to 30 months after operation.
Primary Lymphoma of the Central Nervous System Diagnosed by Computed Tomographic Scan-directed Needle Biopsy with a Frozen Section Immunoperoxidase Technique
Authors: Pearl Gary S. , Chan Wing C. , Bakay Roy A. E. , Wood James H. 
Published: August 2004

Abstract

Primary lymphoma of the central nervous system is an uncommon neoplasm that requires definitive diagnosis because it is potentially treatable. We report a case in which the diagnosis of lymphoma was unsuspected and was made by needle biopsy with computed tomographic scan direction. A frozen section immunoperoxidase technique demonstrated monoclonality. When combined with a compatible morphological appearance, this confirmed the diagnosis of lymphoma. This case demonstrates the importance of this immunochemical method in the rapid diagnosis of central nervous system lymphomas. (Neurosurgery 16:1–4, 1985)
Experimental Carotid Aneurysms: Part 2
Authors: Kerber Charles W. , Cromwell Laurence D. , Zanetti Paul H. 
Published: August 2004

Abstract

Using our modification of the vein patch technique, we created 16 aneurysms in the common carotid arteries of dogs. After a stabilizing and healing period, these aneurysms were treated using percutaneous catheter techniques. Coaxial microcatheters were placed into the aneurysms, and a mixture of isobutyl 2-cyanoacrylate and tantalum dust was infused through the microcatheter using real time fluoroscopic control. Fifteen of the 16 aneurysms were successfully occluded; 1 was a failure because of total occlusion of the carotid artery. One human facial artery aneurysm was similarly treated. The ease and technical details of the treatment are discussed. Although the results are encouraging, we believe that it would be prudent to broaden the animal experimentation rather than to begin human use. Because no experimental aneurysm models are yet physiological, our results must be applied with caution to human intracranial aneurysms. (Neurosurgery 16:13–17, 1985)
Terminal Myelocystocele
Authors: McLone David G. , Naidich Thomas P. 
Published: August 2004

Abstract

Terminal myelocystoceles constitute approximately 5% of skin-covered lumbosacral masses and are especially common in patients with cloacal exstrophy. Pathologically, terminal myelocystocele consists of (a) a skin-covered lumbosacral spina bifida (b) an arachnoid-lined meninogocele that is directly continuous with the spinal subarachnoid space; and (c) a low-lying, hydromyelic spinal cord that traverses the meningocele and then expands into a large terminal cyst. The terminal cyst bulges into the extraarachnoid compartment caudal to the meningocele and forms a distal sac that does not communicate with the subarachnoid space. The terminal cyst is lined by ependyma and dysplastic glia, is directly continuous with the dilated central canal of the cord, and probably represents a ballooned terminal ventricle. Patients with terminal myelocystocele have normal intellectual potential and are usually born without neurological deficit, so these defects must be identified and repaired early, before the onset or progression of lower extremity pareses. (Neurosurgery 16:36–43, 1985)
Treatment of Cerebrospinal Fluid Rhinorrhea by Percutaneous Lumboperitoneal Shunting: Review of 15 cases
Authors: Bret Philippe , Hor Frédéric , Lapras Claude , Fischer Georges 
Published: August 2004

Abstract

Fifteen patients with recalcitrant cerebrospinal fluid (CSF) fistula underwent the insertion of a lumboperitoneal shunt. The shunt consists of a two-piece Silastic tube and has been used in a population of 150 patients with communicating hydrocephalus, persistent postoperative meningocele, and benign intracranial hypertension. The spinal catheter is introduced subcutaneously and no flushing device is used. We studied three groups: 9 patients had a history of head trauma, and 7 of these had undergone one or several ineffective direct approaches to the dural leak. Four patients presented with a presumably congenital fistula. Two patients had persistent rhinorrhea due to previous intracranial procedures. Indium-111 cisternography was performed in 10 patients before lumboperitonel (LP) shunting and failed in 2 of those to document the site of leakage. Twelve patients showed cessation of rhinorrhea after LP shunting. In 4 of these, shunt-related complications responded to shunt removal with no further recurrence of rhinorrhea. Two patients underwent revision of the shunt. In 3 patients, the LP shunt failed to control the CSF leak and further intracranial procedures were indicated. The LP shunt provides and attractive and technically simple solution when direct methods of treatment have failed. Additionally, LP shunting should be considered as a primary mode of treatment in elderly patients or when impairment of CSF dynamics is documented by radionuclide cisternography and computed tomographic scanning. When an LP shunt is ineffective, shunt function should be checked by isotopic studies before additional surgery is performed. (Neurosurgery 16:44–47, 1985)
Evaluation of Cerebrospinal Fluid Rhinorrhea by Metrizamide Computed Tomographic Cisternography
Authors: Ahmadi Jamshid , Weiss Martin H. , Segall Hervey D. , Schultz David H. , Giannotta Steven L. 
Published: August 2004

Abstract

Seven interesting and instructive cases of cerebrospinal fluid rhinorrhea evaluated by metrizamide computed tomographic cisternography are presented. The rhinorrhea was spontaneous in three patients and was related to previous head trauma or surgical procedures in four patients. The anatomical site and the extent of the fistula were demonstrated precisely by directly showing metrizamide passing through the bony defect. A combination of bone dehiscence and metrizamide within the adjacent paranasal sinuses or the nasal cavity is also useful in localization. Distortion of the interhemispheric fissure, sylvian fissure, or basal sulci indicates the probability of brain herniation through the defect. (Neurosurgery 16:54–60, 1985)
Fibrous Mass Complicating Epidural Morphine Infusion
Authors: Rodan Bruce A. , Cohen Fred L. , Bean William J. , Martyak Stephen N. 
Published: August 2004

Abstract

The benefits of continuous epidural morphine infusion using an implanted pump delivery system to control intractable cancer pain have recently been described. Most articles on this subject relate to dosage, technique, degree of pain relief, and tolerance. There are some anticipated complications of the treatment related to the surgical implantation of the system and drug toxicity. We present a complication presumably related to the epidural catheter. A fibrous reaction that developed around the catheter tip progressed into a mass. This caused a significant displacement of the spinal cord with the development of long tract symptoms. Identification of this abnormality using myelography and computed tomography led to prompt surgical decompression resulting in improvement of the patient's condition. (Neurosurgery 16:68–70, 1985)
Traumatic Decerebracy with Preserved Consciousness and Voluntary Movement
Authors: Pattisapu Jogi , Smith Robert R. , Bebin Jose , Wood James H. 
Published: August 2004

Abstract

Decerebrate rigidity is a frequent occurrence in cases of craniocerebral trauma. It is almost always accompanied by coma and usually denotes a poor prognosis. Primary focal brain stem lesions due to trauma are uncommon and may be accompanied by other diffuse cerebral lesions. This report reviews the anatomical basis and clinical findings of a unilateral brain stem lesion in a patient with traumatic decerebracy and preserved consciousness. The anatomical pathways and possible physiological mechanism are discussed, and a few comments on the prognosis of such lesions are given. (Neurosurgery 16:71–74, 1984)
Giant Cell Granuloma of the Orbit with Intracranial Extension
Authors: Sebag J. , Chapman P. , Truman J. , Riemersma R. R. 
Published: August 2004

Abstract

An 8-year-old boy presented with acute proptosis of the right eye. Examination revealed 8 mm of exophthalmos, limitation of upward gaze, optic disc swelling, and normal visual acuity, but an inferonasal quadrantic visual field defect. Orbital ultrasound and computed tomographic scanning demonstrated a superotemporal tumor of the right orbit with intracranial extension. At operation, this proved to be a “reparative” giant cell granuloma. After partial resection, the remaining mass resolved spontaneously without further specific treatment. There had been no recurrence at the 1-year follow-up examination. (Neurosurgery 16:75–81, 1985)
Malignant Melanoma of the Spinal Epidural Space Metastasized from the Enucleated Left Eye after Nine Years without Symptoms: Report of a Case
Authors: Yanai Yoshimi , Wakao Tetsuo , Fukamachi Akira , Kunimine Hideo , Wada Hirochiyo 
Published: August 2004

Abstract

A case of flaccid paraplegia due to a metastatic spinal epidural melanoma is reported. Symptoms occurred approximately 9 years after the enucleation of the left eye. A solid melanotic mass was removed almost totally. Three years after the operation, the patient had not regained the motility of the lower limbs. The need for long term follow-up and management of patients with such problems is discussed, and the pertinent literature is reviewed. (Neurosurgery 16:79–82, 1985)
Primary Pituitary Carcinoma: A Clinical Pathological Study
Authors: Nudleman Kenneth L. , Choi Ben , Kusske John A. 
Published: August 2004

Abstract

A 60-year-old woman presented with a history of headache and rapidly progressive complete bilateral ophthalmoplegia. Her endocrine function was normal. Radiographic studies revealed signs of diffuse destruction of the sella turcica by a tumor without suprasellar extension. Biopsies of the lesion within the sphenoid sinus demonstrated the presence of a primary pituitary carcinoma; autopsy findings revealed metastatic deposits in the liver, kidney, and lung. The histological characteristics of these cells and the electron microscopic findings confirmed that the tumor can first manifest themselves by the rapid development of unilateral or bilateral ophthalmoplegia; this diagnosis should be considered in all individuals with such a syndrome. (Neurosurgery 16:90–95,1985)
Atresia of the Foramen of Monro Resulting in Severe Unilateral Hydrocephalus with Subfalcial Herniation and Infratentorial Diverticulum
Authors: Oi Shizuo , Yamada Hiroshi , Sasaki Koji , Matsumoto Satoshi 
Published: August 2004

Abstract

A case of severe unilateral hydrocephalus associated with ventricular diverticulum and subfalcial herniation secondary to likely atresia of the foramen of Monro is presented. Both atresia of the foramen of Monro and ventricular diverticulum are rare conditions in hydrocephalus. The case presented here is the third reported case with both unique entities. (Neurosurgery 16:103–106, 1985)
Time Course and Spatial Distribution of Neodymium: Yttrium-Aluminum-Garnet (Nd:YAG) Laser-induced Lesions in the Rat Brain
Authors: Eggert Hans R. , Kiessling Marika , Kleihues Paul 
Published: August 2004

Abstract
Cerebral lesions made by focal neodymium: yttrium-aluminum-garnet (Nd: YAG) laser irradiation of the rat forebrain were studied in adult Wistar rats. For the analysis of time-dependent changes, the brains of 28 animals were irradiated with a constant energy density of 461 J/cm2. In this series, survival time ranged from 0.5 hours to 80 days. Immediately after irradiation, a circular lesion appeared on the surface of the brain. This lesion was surrounded by an edematous area intensively stained with Evans blue. At energy levels higher than 30 J, this circular edema contained numerous thrombosed vessels. Histopathologically, the lesion consisted of three distinct zones: the central coagulation necrosis was surrounded by a zone of delayed colliquation necrosis and by perifocal edema. At approximately 80 days after irradiation, the resulting cortical defect was covered by a pial membrane. Edematous changes of the brain cortex and the adjacent white matter were observed as early as 1 hour after irradiation. Within 16 hours, the perifocal edema spread over the white matter of both hemispheres, and it had disappeared by the 5th day after irradiation. In a second experiment, the energy density varied from 231 to 3077 J/cm2. This series consisted of 84 animals that were allowed to survive 48 hours. The size of the lesion depended on the level of energy applied, but the depth of the lesion varied less than the diameter at the brain surface. The depth ranged from 1.3 mm at 20 J to 3.1 mm at 140 J, and the diameter of the lesion at the brain surface varied from 1.3 mm at 15 J to 5.8 mm at 140 J. The results obtained suggest that the Nd: YAG laser can be used for tumor coagulation with minimal risk of adverse effects on the adjacent brain.
Comparison of the Effect of the Carbon Dioxide Laser and the Bipolar Coagulator on the Cat Brain
Authors: Cozzens Jeffrey W. , Cerullo Leonard J. 
Published: August 2004

Abstract
The carbon dioxide laser has recently received clinical acceptance in neurosurgical practice. There are, however, few studies reported in the neurosurgical literature, either clinical or experimental, concerning its safety or efficacy on a physiological level by comparison to a more conventional tool. This study is not a description of a surgical technique, but is rather a basic physiological comparison of two surgical instruments. In this study, 11 cats were pretreated with the protein-bound dye, Evans blue. A corticotomy was performed in one hemisphere with the carbon dioxide laser and in the other with a microbipolar coagulator and a sharp blade. The subsequent extravasation of dye was presumed to be proportional to the amount of blood-brain barrier disruption associated with each lesion. When effective power settings for the two devices were compared, the laser lesions had significantly less extravasation of blue dye. This indicated that there was less damage to the blood-brain barrier surrounding laser corticotomy than surrounding conventional bipolar coagulation and sharp dissection at comparable power settings for each modality.
Use of Antidromic Recording to Monitor Facial Nerve Function Intraoperatively
Authors: Richmond Isabelle L. , Mahla Michael 
Published: August 2004

Abstract
This report describes a technique for monitoring facial nerve activity intraoperatively utilizing antidromic nerve stimulation and sequential averaging of the evoked responses. Compound facial nerve action potentials are obtained reliably even in the presence of paralyzing doses of muscle relaxants, which render the conventional methods useless. The electrophysiological setup is straightforward, and we utilize the same sequential averaging equipment with which we monitor cortical evoked responses intraoperatively. This technique facilitates identification of the facial nerve in large cerebellopontine angel tumors with minimal mechanical trauma. Recordings from eight clinical cases are presented to illustrate the reliability and reproducibility of this technique.
Intraoperative Ultrasound for Spinal Lesions
Authors: Chadduck William M. , Flanigan Stevenson 
Published: August 2004

Abstract
A variety of spinal pathological processes demonstrated by intraoperative ultrasound is presented. Use of spinal ultrasound proved helpful in viewing alignment, assessing spinal cord pathology, and viewing anterior to the cord in cases of spinal trauma. As an operative adjunct, ultrasound was especially helpful for viewing extradural spinal metastases and cavitary lesions of the spinal cord, such as syrinxes, cystic tumors, and hematomas. In cases of spondylotic myelopathy, intraoperative ultrasound allowed assessment of the adequacy of the decompression, the space ventral to the cord, and the size and configuration of the spinal cord.
Aneurysms Associated with Moyamoya Disease
Authors: Konishi Yoshifumi , Kadowaki Chikafusa , Hara Mitsuhiro , Takeuchi Kazuo 
Published: August 2004

Abstract
Seven cases of moyamoya disease accompanied by an aneurysm were studied. The patients, two males and five females, were 13 to 57 years old (average, 32). The cases were classified into two groups: Group A (five cases), in which the aneurysm was located within the moyamoya vessels, and Group B (two cases), in which the aneurysm was located within the circle of Willis and remote from the moyamoya vessels. In all Group A cases, the presenting episode was intracerebral and intraventricular hemorrhage due to rupture of the aneurysm. One patient suffered two separate attacks. In this case, the aneurysm disappeared spontaneously. In one of the two Group B cases, there was hemorrhage from an anterior communicating artery aneurysm. In the other case, with a basilar-superior cerebellar artery aneurysm, there was hemorrhage from the moyamoya vessels.
Confirmation of Brain Death with Portable Isotope Angiography: A Review of 204 Consecutive Cases
Authors: Goodman Julius M. , Heck Larry L. , Moore Brian D. 
Published: August 2004

Abstract
Intravenous isotope angiography is a rapid, safe, and specific bedside test for confirming brain death by demonstrating the lack of critical cerebral perfusion that occurs in this condition, regardless of etiology. A review of 204 consecutive cases of suspected brain death studied with isotope angiography has reaffirmed our confidence in the specificity of the technique and has convinced us to make less stringent our radiographic criteria for confirming brain death by this method. A technically satisfactory single flow study that shows arrest of the carotid circulation at the base of the skull and absence of the intracranial arterial circulation may be considered confirmatory of a carefully established clinical diagnosis of brain death, even though there may be some visualization of the intracranial venous sinuses. Arbitrary waiting periods, withdrawal of sedative drugs, and electrophysiological studies are not needed when this technique is used.