February 15, 2012, 0:00

Ramsis F Ghaly, Kenneth D Candido, Ruben Sauer, Nebojsa Nick KnezevicSurgical Neurology International 2012 3(1):26-26Background: Type I Arnold-Chiari malformation (ACM) has an adult onset and consists of a downward displacement of the cerebellar tonsil...

February 7, 2012, 18:28

Note: To view this in full-screen, click the button on the bottom-right; press Esc to exit full-screen mode. To view this presentation on a mobile device, click the link below. Brain tumor, post rhabdoid meningioma View more presentations from Surgical Neurology International.

January 25, 2012, 22:34

Russian Neurosurgical Journal; Vol 3, No 4 View more documents from Surgical Neurology International.

January 23, 2012, 10:22

What is it? Papers is a software application for Mac OS X, iPhone and iPad that manages your library of (scientific) literature. It can be downloaded from http://www.mekentosj.com: the Mac-version costs €59 / $79, and there is a free 30-day trial available. Papers Touch, the iOS version, costs €12 / $15: this is a so-called … Continue reading Papers: Software for Research →

January 23, 2012, 10:12

More info is available here.

January 23, 2012, 9:58

And here is number 5 out of 5 of the surgical guidelines of the Brain Trauma Foundation: depressed cranial fractures. In my earlier posts you read about on epidural hematoma, acute subdural hematoma, traumatic parenchymal lesions, and posterior fossa mass lesions. Before implementing the final part I needed to fix a technical problem. I ended up creating a workaround that does the job, so here we … Continue reading Decision support for depressed cranial fractures →

January 21, 2012, 0:00

George I Chovanes, Rafael M Richards

Surgical Neurology International 2012 3(1):12-12

Background: The influence of cerebral perfusion pressure (CPP) on real-time focal cerebral blood flow (fCBF) is not fully understood, in either intact or injured brain. We wanted to evaluate that relationship, and by implication investigate the relative importance of perfusion pressure versus metabolism in the regulation and control of cerebral blood flow. Our hypothesis was that metabolic needs dominated over a physiologic range of blood pressure. Methods: This was an observational study of 23 patients, most of them with closed head injury, three with subarachnoid hemorrhage, one with a gunshot wound to the brain, and one monitored after craniotomy for unruptured aneurysm. Arterial lines, ventriculostomies, and fCBF monitors were placed. CPP (mean arterial pressure &#8722; intracranial pressure) and fCBF were measured and recorded to a computer database every minute. The relationship between CPP and fCBF was graphed and correlation coefficients were compared between survivors and non-survivors. Results: Graphs of CPP versus fCBF did not show any linearity over a range of 50-150 mm Hg in patients who survived. In those who died, four of seven showed some indication of linearity. The difference in the correlation coefficients between survivors and non-survivors was statistically significant (P < 0.05), with survivors having essentially no correlation, as expected with autoregulation intact, and non-survivors having a mean correlation of 0.311. Conclusions: In the functioning and viable brain, metabolic regulation of cerebral blood flow (CBF) predominates, leading to the lack of an obvious relationship between perfusion pressure and flow. This predominance of metabolic regulation is robust and preserved over a wide range of brain injury, with pressure autoregulation necessary but not clinically apparent in the metabolically active brain. This robust and constantly varying relationship of pressure and flow shown by our real-time measurements of fCBF has important implications for interpreting clinical measurements of autoregulation. Perhaps most importantly, the development of a correlation between pressure and flow may indicate and be an early warning of deterioration.

January 21, 2012, 0:00

Ryosuke Tomio, Makoto Katayama, Nobuo Takenaka, Tomoyuki Imanishi

Surgical Neurology International 2012 3(1):1-1

Background: Rosai-Dorfman disease (RDD) was first described in 1969 as an idiopathic histiocytic proliferative disorder. It commonly presents as a massive and painless adenopathy. Until 1990, extranodal involvement of the central nervous system (CNS) was rare and reported in less than 5% of the total number of patients with extranodal RDD. Complete removal of CNS RDD has been achieved in many cases. Case Description: We report a case of an isolated intracranial RDD in a 53-year-old man. The patient had an episode of generalized seizures. Imaging studies of the brain were compatible with a meningioma en plaque. The mass was exposed by a right frontotemporal craniotomy. The tumor was adhered tightly to the adjacent cerebral cortex and was permeated by pial arteries of the brain surface. The sacrificing of these arteries was inevitable in order to achieve the total removal of the tumor. The patient had incomplete left hemiparesis after the surgery. Brain computed tomography (CT) imaging revealed a postoperative hemorrhage and a low-density lesion in the right frontal lobe. The patient was postoperatively diagnosed with isolated central nervous system RDD. Conclusion: Although the complete removal of dural-based lesions without any neurological deficits has been performed in many cases, the treatment of cases with high risks, such as the present case, indicates conservative excisions and adjuvant radiotherapy with or without chemotherapy.

January 21, 2012, 0:00

Ali Harati, Jarno Satopää, Lydia Mahler, Romain Billon-Grand, Ahmed Elsharkawy, Mika Niemelä, Juha Hernesniemi

Surgical Neurology International 2012 3(1):6-6

Background: Spinal hemangioblastomas (HB) are rare, histologically benign, highly vascularized tumors often associated with von Hippel-Lindau (VHL) disease. The aim of the current study is to demonstrate the benefit of early surgical resection of large spinal HBs in selected asymptomatic patients with VHL. Methods: Seventeen patients underwent microsurgical resection of 20 spinal HBs at the Department of Neurosurgery at Helsinki University Central Hospital (HUCH). Thirteen tumors were in the cervical spine, five in thoracic and one patient had two lumbar lesions. MRI tumor showed an associated syrinx in 16 patients (94%). Tumor volume ranged from 27 to 2730 mm3 . Out of 17 patients, 11 (65%) tested positive for VHL in mutation analysis. Five of these patients with tumors ranging from 55 to 720 mm3 were treated prophylactically. Results: Complete tumor resection was performed in 16 patients (94%) who were followed up for a median of 57 months (range 2-165 months). No patient had neurological decline on long-term follow-up. Among the patients with VHL, five patients with preoperative sensorimotor deficits showed improvement of their symptoms but never regained full function. One patient who presented with tetraplegia remained the same. Otherwise, all five patients with prophylactic surgery remained neurologically intact. Conclusion: Although documented growth on serial MRIs and the need for pathological diagnosis have been suggested as indications for surgery in otherwise asymptomatic patients, our series showed that a potentially larger group of asymptomatic patients with spinal HB associated with VHL would benefit from microsurgical resection. Long-term results of the surgical management of spinal HB are generally favorable. Our results suggest staging and early treatment for spinal HB larger than 55 mm3 , especially in patients with VHL. Small spinal HBs may be followed up.

January 10, 2012, 18:21

One month ago we gave you a sneak preview on our upcoming reference style to use with Papers, a Mac-alternative for EndNote. Now we made this style available for download at our Author Instructions page. It has also been validated and uploaded to GitHub, according to the suggestion of our reader Rintze Zelle.