Cerebral revascularization with an artificial graft: long-term follow-up and discussion of the role of graft pretreatment with modified host endothelial cells.

Controversy remains regarding the effectiveness of EC/IC bypass for the prevention of stroke and the authors believe that some studies suggest that a subcategory of patients disabled by transient flow-related symptoms may benefit from surgery. The authors present a 7 1/2 year follow-up analysis of a patient who had undergone an EC/IC bypass from the proximal extracranial carotid to the middle cerebral artery using a 4 mm Gore-Tex prosthesis. Following his death from pulmonary sepsis, the graft was retrieved. Pathological and electron microscopic findings are reviewed.

Villaret's syndrome: a report of two cases.

The syndrome resulting from lesions of the lower four cranial nerves (CN) and the cervical sympathetic chain is known as Villaret's syndrome. We report two cases of the syndrome and emphasize the localizing value of this constellation of signs. The second case is unusual because involvement of the cervical sympathetic chain produced sympathetic overactivity, instead of the usual sympathectomy effect. Increased sympathetic outflow expressed as pupillary dilation, widened palpebral fissure, and facial sweating (the Claude Bernard syndrome) usually occurs as an early manifestation of apical thoracic tumors and has not been previously associated with Villaret's syndrome.

Spinal nerve enhancement with Gd-DTPA: MR correlation with the postoperative lumbosacral spine.

PURPOSE: To search for a probable source of the recurrent signs and symptoms associated with lumbosacral postsurgical syndrome on intravenous gadolinium-enhanced MR. METHODS: A retrospective study of 120 patients with recurrent symptomatology following lumbar disk surgery was carried out with spin-echo MR pre- and postenhancement with gadopentetate dimeglumine (0.1 mmol/kg). In addition, 10 asymptomatic subjects were evaluated at least 6 months postoperatively using the same imaging protocol. RESULTS: 21.6% of the symptomatic subjects (N = 26) had enhancement of one or more spinal nerve root. This enhancement was focal or multisegmental, and involved single or multiple nerve roots. The abnormal neural enhancement was associated with otherwise isolated epidural fibrosis in 88.5%, and with herniated nucleus pulposus in the remaining 11.5%. The overall clinical correlation of single root enhancement with a monoradiculopathy and multiroot enhancement with a polyradiculopathy was 95.7%. However, 21.7% of these same cases also showed additional nerve root enhancement that did not have an overt clinical correlation. All of these latter patients were imaged relatively early in the postoperative period (5 days to 8 months). The 10 patients in the asymptomatic group all manifested degrees of postoperative epidural scarring on MR, but no abnormal radicular enhancement or other associated pathology. CONCLUSION: In the chronic postoperative phase (more than 6 to 8 months), the presence of radicular enhancement on MR imaging in symptomatic individuals, and its absence in asymptomatic subjects, suggests that neural enhancement serves as a marker for active neural pathology that may in certain individuals be related temporally to the signs and symptoms associated with the lumbosacral postsurgical syndrome.

Multifocal cavernous hemangioma of the skull: report of a case and review of the literature.

Primary hemangiomas, which are rare skeletal tumors, represent 0.7% of all osseous neoplasms. They are most commonly found in the vertebral column. They are exceedingly rare in the calvarium, accounting for 0.2% of all bone neoplasms. Most calvarial lesions are unifocal, but multiple hemangiomas have been reported. We present the case history of a 64-year-old man who was admitted with frontal and occipital headaches. He was found to have two radiolucent lesions on plain x-ray, left frontal and left occipital, which proved to be cavernous hemangiomas. The gross appearance, histopathology, radiological findings, and treatment options are reviewed.

Cauda equina syndrome of long-standing ankylosing spondylitis. Case report and review of the literature.

Cauda equina syndrome as a neurological complication of long-standing ankylosing spondylitis was first reported in 1961. The syndrome is relatively uncommon and its pathophysiology is still poorly understood. Based on their experience with such a case, the authors review the clinical, electrographic, histological, and radiographic features of the syndrome, including the findings of magnetic resonance (MR) imaging. The addition of MR imaging to the evaluation of patients with ankylosing spondylitis and the cauda equina syndrome not only aids in the diagnosis of the syndrome but may also provide valuable insight into the pathophysiology of this condition.

Proto-oncogene analyses in brain tumors.

The present study determined which oncogenes (N-myc, c-myc, v-sis, or v-fos) were amplified and which messenger ribonucleic acids (mRNA's) accumulated in 10 primary human brain tumors of neuroectodermal origin. The tumors included four glioblastomas multiforme, one mixed glioma (astrocytoma grade I and ependymoma), one astrocytoma grade II, one cystic cerebellar astrocytoma, one ependymoma, one ganglioglioma, and one medulloblastoma. The relative amounts of polyadenylated (poly(A)+) RNA's homologous to these genes and their copy number were determined using the RNA and deoxyribonucleic acid blot hybridization techniques. The N-myc and v-sis probes hybridized strongly to the poly(A)+ RNA from the same recurrent glioblastoma with gene amplifications (N-myc 80 copies; v-sis three to four copies). The c-myc probe hybridized strongly to the recurrent medulloblastoma without gene amplification. The amplification or abundant accumulation of mRNA's homologous to their oncogenes may be involved in tumorigenesis or the aggressiveness of these malignant brain tumors of neuroectodermal origin and may be good molecular indicators of an extremely malignant state in these tumors.

Polytetrafluoroethylene interposition grafts in vertebral to carotid artery transposition. A long-term follow-up study.

Eight patients undergoing an end-to-side vertebral artery (VA) to common carotid artery transposition between August, 1979, and July, 1982, had a polytetrafluoroethylene (PTFE) interposition graft placed when a direct anastomosis was believed not to be satisfactory. Five of these patients are living; clinical and radiographic follow-up studies over periods ranging between 54 and 82 months show that their transpositions are patent. Two patients died perioperatively, one from an acute anterior myocardial infarction and the other from acute VA occlusion with a propagating thrombus. A third patient died of myocardial infarction 20 months after graft placement; the anastomosis had been found patent at 12 months. This report gives the clinical and radiographic follow-up results in a previously reported group of patients with PTFE interposition grafts. Some of these patients have been followed for over 6 years after surgery: the average radiographic follow-up period in the five survivors is 60 months, and all grafts are patent without evidence of progressive stenosis. Expanded PTFE appears to be an acceptable material for short interposition grafts in operations involving the VA; however, direct artery-to-artery anastomosis is preferred. The results of longer PTFE grafts in reconstructive cerebrovascular surgery have not been adequately studied.

Loss of heterozygosity on chromosome 10 in human glioblastoma multiforme.

Recessive mutations, revealed by loss of the wild-type allele, have been associated with the development of a variety of cancers in children and adults. Polymorphic chromosome 10 markers were used to screen paired tumor and lymphocyte DNA samples in 13 patients with glioblastoma multiforme. Ten patients showed loss of constitutional heterozygosity in the tumor samples. This finding suggests that a recessive gene involved in the development of glioblastoma multiforme is present on chromosome 10.

Expression of three viral oncogenes (v-sis, v-myc, v-fos) in primary human brain tumors of neuroectodermal origin.

We determined which viral oncogenes (v-sis, v-myc, and v-fos) were expressed in five primary human brain tumors of neuroectodermal origin (two glioblastomas multiforme, one medulloblastoma, one cystic cerebellar astrocytoma, and one ganglioglioma) and which of these oncogenes is correlated with malignancy. Using the dot hybridization technique, we determined the relative amounts of mRNA coded by these genes using the same nitrocellulose filter. The v-myc probe showed a 4- to 12-fold greater hybridization to the mRNA from two glioblastomas and the medulloblastoma (malignant group) than the mRNA from the cystic cerebellar astrocytoma or the ganglioglioma (benign group). In contrast, RNA hybridizing to v-sis and v-fos were accumulated to a greater extent in the benign tumors. These data suggest that the amount of myc expression may be correlated with the degree of malignancy of brain tumors of neuroectodermal origin.

40 Hz--middle latency auditory evoked response in comatose patients.

Brain-stem auditory evoked response (BAER) and 40 Hz middle latency auditory evoked response (40 Hz AER) were elicited in 12 comatose patients. The concept of a midbrain generator of 40 Hz AER is being discussed.

Extracranial surgical procedures in the management of vertebrobasilar insufficiency.

Vertebrobasilar insufficiency is an important syndrome in the spectrum of cerebrovascular disease. Its clinical importance and the frequency of its clinical manifestations are often underestimated. Our experience with a large population of patients having extensive cerebrovascular disease has led us to recognize two classes of vertebrobasilar insufficiency--simple and complex--and, also, to recognize that vertebrobasilar insufficiency is often associated with disease in multiple extracranial vessels. Until recently, direct approaches to the vertebral artery have been underutilized for these patients. In fact, there has been a tendency either to relegate patients with vertebrobasilar disease to medical follow-up or to surgical procedures upon the carotid system. We believe that the resurgence of neurosurgical interest in the vertebrobasilar system is most appropriate. Furthermore, the active interest that neurosurgeons are now taking in developing procedures for managing extracranial vertebral artery problems is in the best interest of patients with cerebrovascular disease. We believe that careful neurosurgical evaluation of patients with simple and complex vertebrobasilar insufficiency will lead to appropriate selection of candidates for vascular reconstruction of the vertebral system. Finally, we believe that vertebral artery to common carotid artery transposition, and its variations, is a procedure that has an important role in the management of cerebrovascular disease.

Anatomical correlates of return of locomotor function after partial spinal cord lesions in cats.

We trained cats to walk on a moving treadmill belt, then subjected them to partial transverse sections of the thoracic spinal cord. Afterwards, we observed their ability to walk on the treadmill, over a period of several weeks, using gait analysis techniques to describe the resultant deficits. The extent of the lesions was verified histologically, and the identity of the spared descending axons from the brain stem was demonstrated by retrograde labeling with horseradish peroxidase. We found that significant sparing or recovery of hindlimb locomotor function is closely linked to sparing of axons in at least one ventrolateral quadrant of the cord. The essential elements probably belong to vestibulospinal and reticulospinal systems.