Journal of neurosurgery
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Journal of neurosurgery · Feb 1994
Case ReportsHydrocephalus due to villous hypertrophy of the choroid plexus in the lateral ventricles. Case report.
A case is reported of hydrocephalus due to overproduction of cerebrospinal fluid (CSF) caused by villous hypertrophy of the choroid plexus in the lateral ventricles. A 7-year-old girl with mental retardation developed gait disturbance; hydrocephalus and a Dandy-Walker cyst were detected on computerized tomography. She was initially treated with a ventriculoperitoneal shunt; however, shunting failed to control the hydrocephalus. ⋯ The patient was therefore diagnosed as having hydrocephalus induced by overproduction of CSF, which was controlled by resection of the choroid plexus. Histological examination showed the structure typical of normal choroid plexus. This is a rare case of villous hypertrophy of the choroid plexus in which MR imaging assisted in the diagnosis.
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Journal of neurosurgery · Feb 1994
Biography Historical ArticleLouise Eisenhardt, M.D.: first editor of the Journal of Neurosurgery (1944-1965).
This is a literary portrait of Louise Eisenhardt, M. D., associate of Harvey Cushing, scholar, investigator, editor, teacher, and curator of the Brain Tumor Registry at Yale. She was a Charter Member of the Harvey Cushing Society which she served as President, long-term Secretary-Treasurer, and Historian. ⋯ A figure in the Homeric tradition of observing accurately and reporting honestly, Dr. Eisenhardt set high standards for both colleagues and students as well as for aspiring medical authors. She left a tradition worthy of emulation.
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Journal of neurosurgery · Feb 1994
Biodegradable polymers for controlled delivery of chemotherapy with and without radiation therapy in the monkey brain.
Sustained drug delivery by biodegradable polymer devices can increase the therapeutic efficacy of drugs by producing high local tissue concentrations over extended periods of time. It has been shown previously that implantation of controlled-release polymers impregnated with the nitrosourea carmustine (BCNU) extended the period of survival in rats bearing the 9L glioma compared with similar rats treated with systemically administered BCNU. This study evaluated the effect on the monkey brain of interstitial delivery of BCNU by the biodegradable polyanhydride copolymer poly[bis(p-carboxyphenoxy)propane]anhydride (PCPP) and sebacic acid (SA) in a 20:80 formulation (PCPP:SA). ⋯ No neurological or general deleterious effects were seen in any of the animals. It is concluded that the interstitial delivery of BCNU by the polyanhydride polymer PCPP:SA is safe in the primate brain and that concomitant radiation therapy did not lead to any adverse effects. These experimental findings are important to an understanding of the clinical effects of PCPP:SA implants in treating brain diseases.
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Journal of neurosurgery · Jan 1994
Delayed induction of mild hypothermia to reduce infarct volume after temporary middle cerebral artery occlusion in rats.
Deep to moderate hypothermia (24 degrees to 30 degrees C) during focal cerebral ischemia reduces infarct volume but must be initiated before the onset of ischemia to be effective and has deleterious pulmonary, myocardial and neurological effects. It is not known whether mild hypothermia (32 degrees to 33 degrees C) protects against ischemic neuronal damage, whether hypothermia induced after the onset of ischemia has protective effects, or whether these effects are associated with alterations in cortical blood flow. ⋯ Cortical blood flow, measured by laser Doppler ultrasound flowmetry, was not significantly different between groups during ischemia; however, postischemic cortical blood flow correlated positively with total infarct volume. These results indicate that mild hypothermia initiated during temporary focal ischemia in rats can reduce infarct volume without attenuating the reduction in cortical blood flow.
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Journal of neurosurgery · Jan 1994
Case ReportsRecurrence of ICA-PCoA aneurysms after neck clipping.
Between 1975 and 1992, 2211 patients underwent aneurysmal neck clipping at the Nara Medical University clinic and associated hospitals. The aneurysm in 931 of these patients was situated at the junction of the internal carotid artery (ICA) and posterior communicating artery (PCoA). Seven patients were readmitted 4 to 17 years after the first surgery because of regrowth and rupture of an ICA-PCoA aneurysmal sac that had arisen from the residual neck. ⋯ Type 2 includes aneurysms in which the proximal portion of a previous clip is situated at the corner of the ICA and aneurysmal neck and the distal portion on the enlarged dome of the aneurysm, because the sac is regrowing from a portion of the residual neck. In this type of aneurysm, a Sugita fenestrated clip can occlude the residual neck, overriding the old clip. Classifying these aneurysms into two groups is very useful from a surgical point of view because it is possible to apply a new clip without removing the old clip, which was found to be adherent to surrounding tissue.