Showing papers in "Journal of Neurosurgery in 1974"
TL;DR: A balloon catheter technique for catheterization of human cerebral blood vessels was successfully accomplished in more than 300 cases, including investigations of collateral blood flow, intraarterial pressure, brain temperature, the vital staining of tumors, and the introduction of chemical agents.
Abstract: ✓ A balloon catheter technique for catheterization of human cerebral blood vessels is described. Temporary occlusion of different cerebral vessels was successfully accomplished in more than 300 cases, including investigations of collateral blood flow, intraarterial pressure, brain temperature, the vital staining of tumors, and the introduction of chemical agents. Temporary occlusion of the internal carotid artery makes possible angiography of the external carotid, while occlusion of separate branches of the external carotid permits selective angiography of its functioning branches. The balloon catheter is valuable in investigating arteriovenous and carotid-cavernous fistulas. With the help of a detachable balloon it is possible to occlude the cavity of arterial aneurysms or the afferent vessels of arteriovenous aneurysms; it is also useful as a means to shut off the blood flow to arterial aneurysms and carotid-cavernous fistulas when access is difficult. A method for reconstruction of the cavernous part o...
831 citations
TL;DR: The results of retrogasserian differential lidocaine block are described to aid in the selection of patients for a differential thermal lesion in the trigeminal ganglion and rootlets.
Abstract: ✓ The authors report their experience in the treatment of trigeminal neuralgia with controlled increments of radiofrequency heating from an electrode placed in the Gasserian ganglion or its posterior rootlets. Touch is preserved in some or all of a trigeminal zone rendered analgesic. The electrode tip is introduced through the foramen ovale and placed among the desired rootlets with the help of a combination of radiographs and the conscious patient's response to electrical stimulation with a square wave signal and gentle electrical heating. The degree of heat is measured by a thermister at the electrode tip. The patient's cooperation is maintained by the use of the neurolept anesthetic Innovar and the production of brief unconsciousness for the painful parts of the operation by methohexital (Brevital). Of 274 patients with facial pain so treated, 214 had trigeminal neuralgia; 91% of the latter group experienced relief of pain and 125 followed for 2½ to 6 years had a recurrence rate of 22%. In a total of 3...
580 citations
TL;DR: It seems clear that a useful number of electrodes could be implanted in virtually every patient for the development of a functional visual prosthesis for the blind based on stimulation of the visual cortex.
Abstract: ✓ The topographical anatomy of the primary visual cortex in man was studied by macroscopic identification and measurement of the line of Gennari on coronal sections from 52 hemispheres collected at autopsy Computer analysis of these data provided detailed, quantitative information concerning the amount, variability, and distribution of the striate area on the surface of the occipital lobe, and within the calcarine fissure and other sulci This information is particularly applicable to the development of a functional visual prosthesis for the blind based on stimulation of the visual cortex Taking conservative values for two-point discrimination (3 mm) on the cortex based on previous observations made during neurosurgical operations, and the surgically accessible areas available for stimulation reported in this study, it seems clear that a useful number of electrodes could be implanted in virtually every patient
417 citations
TL;DR: In this article, the authors used a small volume chamber to determine the contractile activity of various vasoactive agents on the basilar and middle cerebral arteries, and concluded from these curves, and the known concentrations in blood, that serotonin is probably the agent in blood responsible for the cerebral arterial spasm that often follows a subarachnoid hemorrhage.
Abstract: ✓ In vitro experiments were performed using a small volume chamber to determine the contractile activity of various vasoactive agents on the canine basilar and middle cerebral arteries. Cumulative dose-response curves were obtained for most of the agents tested including serotonin and three different prostaglandins; many of these curves were found to be similar for segments from both arteries. It was concluded from these curves, and the known concentrations in blood, that serotonin is probably the agent in blood responsible for the cerebral arterial spasm that often follows a subarachnoid hemorrhage. This in vitro method is capable of detecting serotonin concentrations as low as 10−12 gm/ml and may prove useful as a quantitative and well-controlled method for studying the etiology of spasm and the receptor mechanisms present in the cerebral arteries.
380 citations
TL;DR: In this paper, a series of patients with idiopathic normal pressure hydrocephalus was divided into two groups on the basis of shunt response and the relative predictive values of preoperative tests.
Abstract: ✓ After shunting, 43 patients with normal-pressure hydrocephalus were followed for 6 to 30 months. All patients had complete preoperative clinical evaluations, pneumoencephalograms, and isotope cisternography; in addition, 21 had saline infusion studies, and 15 had biopsies. Of the 10 patients in whom the etiology of the hydrocephalus was known eight (80%) were significantly improved. Of the other 33 patients, 21 (64%) showed some improvement; this was substantial and sustained in only eight (24%). The whole series of patients with idiopathic normal pressure hydrocephalus was divided into two groups on the basis of shunt response and the relative predictive values of preoperative tests. No significant association was found between the results of shunting and preoperative clinical factors, pneumoencephalography, isotope cisternography, saline infusion tests, or various combinations of clinical and laboratory abnormalities. The significance of these findings is discussed.
370 citations
TL;DR: It is concluded that this type of subacute traumatic BE, which is significantly associated with surgical lesions, is not of majo...
Abstract: ✓ The authors have assessed the effects of subacute traumatic brain edema (BE) on cerebral circulation and metabolism, and on clinical outcome. Fifty-five severely injured, comatose, young patients who survived for more than 24 hours were studied on 78 occasions within 30 days of injury. After hematomas had been surgically evacuated, BE was diagnosed by radiological evidence of brain swelling, demonstrated by cerebral angiograms and ventriculograms. At identical levels of carbon dioxide pressure, intracranial pressure was significantly elevated in the Edema Group to twice the value in the No Edema Group (27.1 vs 14.1 torr). There were, however, no significant differences in cerebral perfusion pressure, cerebral blood flow, resistance to blood flow, cerebral metabolic oxygen rate, ventricular cerebrospinal fluid acidbase, lactate, K+ or Na+ concentrations, or in clinical outcome. It is concluded that this type of subacute traumatic BE, which is significantly associated with surgical lesions, is not of majo...
336 citations
TL;DR: An all-transistorized bipolar coagulator has been designed featuring a thermocontrolling mechanism which consists of a thermOCouple concealed in the tip of the forceps, which avoids the complication of the adherence of tissue to the coagulating instrument.
Abstract: ✓ An all-transistorized bipolar coagulator has been designed featuring a thermocontrolling mechanism which consists of a thermocouple concealed in the tip of the forceps. This avoids the complication of the adherence of tissue to the coagulating instrument.
313 citations
TL;DR: The authors report a case in which a true synovial cyst was found attached to a cervical facet joint, and the anatomically oriented term “juxta-facet cyst” is proposed to include both ganglion and synovIAL cysts seen in this area.
Abstract: ✓The authors report a case in which a true synovial cyst was found attached to a cervical facet joint. The differential diagnosis involving herniated cervical disc as well as other types of extradural cyst is discussed. The anatomically oriented term “juxta-facet cyst” is proposed to include both ganglion and synovial cysts seen in this area.
258 citations
TL;DR: This review of spinal cord injury research has placed special emphasis on the controversial issues appropriate to a new, stimulating, and competitive area of research.
Abstract: ✓ In this review of spinal cord injury research, the author has selected contributions which in his opinion best represent modern experimental concepts regarding the mechanism and management of spinal cord injuries. He has placed special emphasis on the controversial issues appropriate to a new, stimulating, and competitive area of research.
235 citations
TL;DR: The history, physical findings, and treatment of dural arteriovenous malformations are reviewed, and the importance of completely identifying and obliterating the fistula, even at the expense of obliterating major venous sinuses, is emphasized.
Abstract: ✓ The history, physical findings, and treatment of dural arteriovenous malformations are reviewed. The importance of completely identifying and obliterating the fistula, even at the expense of obliterating major venous sinuses, is emphasized. Failure of surgical treatment usually is the result of mistaking the more obvious dilated feeding vessels for the lesion itself.
231 citations
TL;DR: The severe spontaneous pain associated with lesions of the central nervous system has been successfully suppressed by electrical stimulation of the posterior limb of the internal capsule by stimulation of parietal corticofugal inhibitory fibers.
Abstract: ✓ The severe spontaneous pain associated with lesions of the central nervous system has been successfully suppressed by electrical stimulation of the posterior limb of the internal capsule. The physiological basis for this result is not understood but the authors's hypothesis is that the pain suppression is due to stimulation of parietal corticofugal inhibitory fibers.
TL;DR: Ventriculography was the most reliable diagnostic study and both the demonstration of dilatation of the lateral ventricles and an upward convexity in the initial segment of the internal cerebral vein in five of the 10 angiograms performed were highly suggestive of tumor.
Abstract: ✓ Thirty-eight cases of colloid cyst of the third ventricle are reviewed. Headache was the most frequent complaint but a strong positional relationship, supposedly a pathognomonic feature of this tumor, was seldom seen. A combination of progressive dementia and gait disturbance without evidence of papilledema, resembling the clinical picture in “normal-pressure” hydrocephalus, was present in eight patients. Sudden deterioration and death occurred in four cases; two other deaths were precipitated by lumbar puncture and pneumoencephalography. Ventriculography was the most reliable diagnostic study. Both the demonstration of dilatation of the lateral ventricles and an upward convexity in the initial segment of the internal cerebral vein in five of the 10 angiograms performed were highly suggestive of tumor. Removal of the colloid cyst through a cortical incision in the non-dominant hemisphere was carried out in 21 cases; in six it was necessary to enlarge the foramen of Monro by dividing the ipsilateral ante...
TL;DR: The authors describe the striking ultrastructural evolution of vacuolar degeneration of the media in subarachnoid arteries that have been in spasm following subarACHnoid hemorrhage.
Abstract: ✓ The authors describe the striking ultrastructural evolution of vacuolar degeneration of the media in subarachnoid arteries that have been in spasm following subarachnoid hemorrhage.
TL;DR: A case of progressive paraparesis is reported in which the normal spinal cord herniated through a defect in the ventral meninges and dura and became incarcerated in a cavity in the dorsal aspect of the body of T-7.
Abstract: ✓ A case of progressive paraparesis is reported in which the normal spinal cord herniated through a defect in the ventral meninges and dura and became incarcerated in a cavity in the dorsal aspect of the body of T-7. Progress of the paraparesis was arrested by reduction of the hernia.
TL;DR: The authors report a retrospective study of 146 patients to assess the extent to which aneurysms, arteriovenous malformations, and pregnancy interact.
Abstract: ✓ The authors report a retrospective study of 146 patients to assess the extent to which aneurysms, arteriovenous malformations, and pregnancy interact. The natural history of the lesions was modified if the women became pregnant. Clinical syndromes, diagnosis, neurosurgical and obstetrical management, and treatment are discussed.
TL;DR: The authors believe that posterior lumbar disc herniations that occur far laterally (beneath, or beyond the facet) present a clinical picture and special problems of diagnosis different from those encountered with the usual herniation within the spinal canal.
Abstract: ✓ The authors believe that posterior lumbar disc herniations that occur far laterally (beneath, or beyond the facet) present a clinical picture and special problems of diagnosis different from those encountered with the usual herniations within the spinal canal. In a series of 204 consecutive disc operations, there were 24 “extreme-lateral” disc herniations at the second, third, or fourth lumbar interspace, none at the lumbosacral joint. When compared with the incidence of posterior herniations above the fourth interspace, it appeared that “extreme-lateral” herniations were responsible for the majority of second, third and fourth lumbar root compressions. The clinical syndrome is characterized by anterior thigh and leg pain, absent knee jerk, and sensory loss in the appropriate dermatome but also by the absence of back pain, typical back signs, or positive Lasegue's sign. Reproduction of pain and paresthesia by lateral bending to the side of the lesion is a reliable diagnostic sign. The authors report tha...
TL;DR: Application of Burton's concept of the critical closing pressure to experimental data on brain-blood flow in the monkey suggests that perfusion pressure, not vascular bed resistance, is the primary variable affecting cerebral blood flow.
Abstract: ✓ Application of Burton's concept of the critical closing pressure to experimental data on brain-blood flow in the monkey suggests that perfusion pressure, not vascular bed resistance, is the primary variable affecting cerebral blood flow. Perfusion pressure for the cerebral circulation is the mean arterial pressure minus the critical closing pressure (MAP — CCP). Vasomotor tone and intracranial pressure are the major determinants of the critical closing pressure. Changes in either of these variables, therefore, affect perfusion pressure and flow. Data on brain-blood flow at fixed vasomotor tone obtained over wide pressure ranges show little change in vascular bed resistance despite significant changes in flow. The diameter of resistance vessels probably does not change significantly throughout the normal physiological range of cerebral blood flow. The limits of the critical closing pressure in the anesthetized monkey are from 10 to 95 mm Hg. Using these limits, and beginning with the average values for M...
TL;DR: Sustained intracranial pressure reduction could be maintained for up to 5 days by combining pentobarbital and hypothermia without cardiovascular instability or other untoward side-effects and may offer a greater protection to the brain during periods of elevated ICP.
Abstract: ✓ Thiopental and pentobarbital caused further reductions in intracranial pressure (ICP) in five patients with persistent intracranial hypertension who had been previously treated with diuretics, steroids, and hyperventilation therapy. The ICP reduction obtained with these patients at normothermia was rapid. Abrupt increases in ICP could be quickly checked by barbiturate treatment. Frequently, the ICP reduction was accompanied by an improvement in the cerebral perfusion pressure. Reduction of ICP by thiopental was brief while that due to pentobarbital was more prolonged. Sustained intracranial pressure reduction could be maintained for up to 5 days by combining pentobarbital (serum concentration 3 mg%) and hypothermia (30°C) without cardiovascular instability or other untoward side-effects. The cerebral metabolic depression due to this combined therapy may be additive and therefore offer a greater protection to the brain during periods of elevated ICP.
TL;DR: It is suggested that intracavernous wire thrombosis may prove to be the treatment of choice in that it seals the fistula without impairing carotid blood flow.
Abstract: ✓ The results of 61 cases of stereotaxic thrombosis of intracranial berry aneurysms indicate that the technique in selected cases is comparable to, but not necessarily superior to standard surgical methods. The results of wire-induced thrombosis in 15 cases of giant intracranial aneurysm suggest that this method is effective in situations where clipping and encapsulation are inapplicable. The results of thrombosis in six cases of carotid cavernous fistula suggest that intracavernous wire thrombosis may prove to be the treatment of choice in that it seals the fistula without impairing carotid blood flow.
TL;DR: Electronmicroscopic examinations of the basilar artery removed during the second stage of this spasm reveal myonecrosis of the media, with fragmentation of myofibrils, dissolution of the sarcolemma, and interstitial edema.
Abstract: ✓ The authors report a new experimental model for the study of delayed intracranial arterial spasm in monkeys The injection of norepinephrine into the prepontine cistern produces an intense immediate vasospasm that disappears in minutes and is followed by a second stage of vasospasm that persists for 8 to 10 days Electronmicroscopic examinations of the basilar artery removed during the second stage of this spasm reveal myonecrosis of the media, with fragmentation of myofibrils, dissolution of the sarcolemma, and interstitial edema
TL;DR: Because of their multiplicity, characteristic broad base, and the small subarachnoid space in the interhemispheric fissure, these aneurysms are judged technically difficult.
Abstract: ✓ A series of 13 patients with saccular aneurysms of the distal anterior cerebral artery, operated on by the same surgeon with microtechniques, is reviewed. The incidence of aneurysms in this location was 3.4%, the median age of the patients 44 years, and the median time from most recent hemorrhage to surgery 13 days. There were five cases of multiple aneurysms. No operative mortality occurred; the operative morbidity was 15%. Because of their multiplicity, characteristic broad base, and the small subarachnoid space in the interhemispheric fissure, these aneurysms are judged technically difficult.
TL;DR: Optic nerve sheath hemorrhage is shown to result from rupture of dural and bridging vessels of the optic nerveSheath dilatation caused by the transmission of intracranial pressure through the subarachnoid communication between the optic nerves sheath and the intrac Cranial cavity.
Abstract: ✓ The eyes of 23 patients with sudden intracranial hypertension were studied at post-mortem. Intraocular hemorrhage had occurred in 37% and optic nerve sheath hemorrhage in 87%. Expansion of the optic nerve sheath, particularly the fusiform retrobulbar portion, was a consistent finding. The subdural space of the optic nerve sheath bore the brunt of the hemorrhage which sometimes communicated with perivascular intradural hemorrhages. Optic nerve sheath hemorrhage is shown to result from rupture of dural and bridging vessels of the optic nerve sheath; this we conclude is subsequent to optic nerve sheath dilatation caused by the transmission of intracranial pressure through the subarachnoid communication between the optic nerve sheath and the intracranial cavity. Intraocular hemorrhage is the result of retinal venous hypertension and rupture brought on by obstruction of both the central retinal vein and the retinochoroidal anastomosis.
TL;DR: Although the new antisiphon valves produced much smaller decrements of CSF pressure with significant clinical improvement in some cases, these units did not always prevent subdural hematomas.
Abstract: ✓ Subdural hematomas and effusions have been noted in at least 20% of adult patients treated with CSF shunts for normal pressure hydrocephalus. In a series of 39 cases the incidence of this complication is correlated with the low 41% improvement rate. The very low intracranial pressure achieved with conventional shunt systems is probably the most important factor causing subdural collections of blood or fluid. In a study of pre- and post-shunt CSF pressures in 25 patients it was found that in the erect position ventriculoatrial and ventriculoperitoneal shunt systems produced pressures averaging —238 and —251 mm H2O respectively. Although the new antisiphon valves produced much smaller decrements of CSF pressure with significant clinical improvement in some cases, these units did not always prevent subdural hematomas.
TL;DR: In vivo experiments in dogs demonstrated that physiological concentrations of serotonin, when injected intracisternally, caused cerebral arterial spasm that lasted for at least 3 hours that was comparable to that produced by the injection of blood containing approximately the same amount of serotonin.
Abstract: In vivo experiments in dogs demonstrated that physiological concentrations of serotonin, when injected intracisternally, caused cerebral arterial spasm that lasted for at least 3 hours. Comparable spasm was produced by the injection of blood containing approximately the same amount of serotonin. Phenoxybenzamine reversed both the spasm produced by pure serotonin and that produced by blood. A hypothesis of the etiology of cerebral arterial spasm is proposed based on the experimental results of the entire study.
TL;DR: Computerized scanning of the brain is a new diagnostic x-rays method that utilizes modern electronic and computer technology for the measurement of the transmission of x-ray photons through tissue.
Abstract: ✓ Computerized scanning of the brain is a new diagnostic x-ray method that utilizes modern electronic and computer technology for the measurement of the transmission of x-ray photons through tissue. The cranium is scanned in successive layers by a narrow beam of x-rays in such a way that the transmission of x-ray photons across a particular slice can be measured, and by means of a computer and a suitable algorithm used to construct a detailed differential picture of the internal structure and tissues of the brain.
TL;DR: A cerebrospinal fluid formation rate of 1.4 ml/min was determined in a 5-month-old child with a choroid plexus papilloma and hydrocephalus, and a measured absorption rate indicated that the patient's capacity for absorption was normal.
Abstract: ✓ With the use of a ventricular perfusion technique, a cerebrospinal fluid formation rate of 1.4 ml/min was determined in a 5-month-old child with a choroid plexus papilloma and hydrocephalus. This rate was slightly greater than four times the rate observed in normal children. The clinical course, as well as a measured absorption rate, indicated that the patient's capacity for absorption was normal.
TL;DR: Although the NE content of the cord in treated animals decreased compared to that of laminectomized controls, the decrease was not significant and the concentration of DA, however, significantly increased after impact and significa...
Abstract: ✓ Concentrations of norepinephrine (NE), dopamine (DA), serotonin (5-HT), and histamine (HIST) were determined in spinal cords of five groups of cats. One group underwent laminectomy only; a second untreated group received a 400 gm-cm impact at the T-9 level. These were compared with three groups treated with epsilon aminocaproic acid (EACA), methyl prednisolone sodium succinate (MP), and a combination of EACA and MP after similar trauma. The biogenic amines were measured in three 1-cm segments of the cord, rostral, middle, and caudal, 1 hour after trauma. There was no change in NE concentration in any of the three segments after impact compared with laminectomized controls, nor was the NE concentration in the impacted (middle) area higher than that in the rostral or caudal sites. Although the NE content of the cord in treated animals decreased compared to that of laminectomized controls, the decrease was not significant. The concentration of DA, however, significantly increased after impact and significa...
TL;DR: The authors, at the invitation of the Editorial Board, have outlined their general interpretation of the role of monoamine neurotransmitters following injury to the central nervous system.
Abstract: ✓ The authors, at the invitation of the Editorial Board, have outlined their general interpretation of the role of monoamine neurotransmitters following injury to the central nervous system. Their work on experimental stroke is discussed, and its relevance to spinal cord injuries accompanied by comparable hemorrhage and ischemia involving neurons is implied.
TL;DR: It is concluded that gradual stenosis of the parasagittal venous pathways took place 1 to 2 mm proximal to the junction of the lateral lacuna and the superior sagittal sinus, regardless of the level of intracranial pressure.
Abstract: ✓ The pressure gradient of the venous pathway between the cortical vein and superior sagittal sinus was measured in adult mongrel dogs by recording the pressures of the bridging vein, lateral lacuna (proximal portion), and superior sagittal sinus, together with the systemic blood pressure while gradually increasing the intracranial pressure up to the level of mean systemic blood pressure. The pressure gradient between the lateral lacuna and the superior sagittal sinus was also measured under increased intracranial pressure. Pressures of the bridging vein and lateral lacuna were constantly 50 to 250 mm H2O higher than the intracranial pressure, regardless of the level of intracranial pressure. An abrupt drop in the intraluminal pressure was observed at a point 1 to 2 mm proximal to the junction of the lateral lacuna and the superior sagittal sinus, regardless of the level of intracranial pressure. It is concluded that gradual stenosis of the parasagittal venous pathways took place 1 to 2 mm proximal to the...
TL;DR: Although these cysts are frequently indistinguishable clinically from spinal cord tumors, their correct early diagnosis by myelography and treatment by excision or marsupialization gives gratifying results.
Abstract: ✓ Six cases of symptomatic spinal arachnoid cysts are presented. All lesions but one were intradural. Although these cysts are frequently indistinguishable clinically from spinal cord tumors, their correct early diagnosis by myelography and treatment by excision or marsupialization gives gratifying results. The authors emphasize that precise diagnosis and definitive treatment are sometimes delayed because of intermittent symptoms.