Large osteolytic skull tumor presenting as a small subcutaneous scalp lesion.

Subcutaneous nodules of the scalp are common and usually benign. We describe a case that presented as a probable inclusion cyst or lipoma of the scalp that was discovered to be a benign osteolytic fibrohistiocytic lesion of the frontoparietal skull. This ultimately was successfully treated by neurosurgery with a craniectomy, tumor excision, and reconstructive cranioplasty.

Cervical decompression and reconstruction without intraoperative neurophysiological monitoring.

Object: The primary goal of this study was to review the immediate postoperative neurological function in patients surgically treated for symptomatic cervical spine disease without intraoperative neurophysiological monitoring. The secondary goal was to assess the economic impact of intraoperative monitoring (IOM) in this patient population.

Methods: This study is a retrospective review of 720 consecutively treated patients who underwent cervical spine procedures.

PrPSc detection in formalin-fixed paraffin-embedded tissue by ELISA.

Background: Formalin-fixed paraffin-embedded tissue is regularly employed in the diagnosis of transmissible spongiform encephalopathies (TSE) by immunohistochemistry (IHC), the standard by which all other TSE diagnostic protocols are judged. While IHC affords advantages over diagnostic approaches that typically utilize fresh or frozen tissue, such as Western blot and ELISA, the process of fixing, staining, and analyzing individual sections by hand does not allow for rapid or high throughput screening. However, preservation of tissues in formalin is not dependent upon the availability of refrigeration.

White-tailed deer are susceptible to the agent of sheep scrapie by intracerebral inoculation.

Interspecies transmission studies afford the opportunity to better understand the potential host range and origins of prion diseases. The purpose of this experiment was to determine susceptibility of white-tailed deer to the agent of scrapie after intracerebral inoculation and to compare clinical signs and lesions to those reported for chronic wasting disease (CWD). Deer (n = 5) were inoculated with 1 mL of a 10% (wt/vol) brain homogenate derived from a sheep clinically affected with scrapie.

Evaluation of two sets of immunohistochemical and Western blot confirmatory methods in the detection of typical and atypical BSE cases.

Background: Three distinct forms of bovine spongiform encephalopathy (BSE), defined as classical (C-), low (L-) or high (H-) type, have been detected through ongoing active and passive surveillance systems for the disease.The aim of the present study was to compare the ability of two sets of immunohistochemical (IHC) and Western blot (WB) BSE confirmatory protocols to detect C- and atypical (L- and H-type) BSE forms.Obex samples from cases of United States and Italian C-type BSE, a U.

Experimental interspecies transmission studies of the transmissible spongiform encephalopathies to cattle: comparison to bovine spongiform encephalopathy in cattle.

Prion diseases or transmissible spongiform encephalopathies (TSEs) of animals include scrapie of sheep and goats; transmissible mink encephalopathy (TME); chronic wasting disease (CWD) of deer, elk and moose; and bovine spongiform encephalopathy (BSE) of cattle. The emergence of BSE and its spread to human beings in the form of variant Creutzfeldt-Jakob disease (vCJD) resulted in interest in susceptibility of cattle to CWD, TME and scrapie. Experimental cross-species transmission of TSE agents provides valuable information for potential host ranges of known TSEs.

Experimental transmission of chronic wasting disease (CWD) from elk and white-tailed deer to fallow deer by intracerebral route: final report.

Final observations on experimental transmission of chronic wasting disease (CWD) from elk (Cervus elaphus nelsoni) and white-tailed deer (Odocoileus virginianus) to fallow deer (Dama dama) are reported herein. During the 5-year study, 13 fawns were inoculated intracerebrally with CWD-infected brain material from white-tailed deer (n = 7; Group A) or elk (n = 6; Group B), and 3 other fawns were kept as uninoculated controls (Group C). As described previously, 3 CWD-inoculated deer were euthanized at 7.

Preservation of spinal instrumentation after development of postoperative bacterial infections in patients undergoing spinal arthrodesis.

Study Design: This is a retrospective review.

Objective: The purpose of this study is to evaluate the efficacy of medical and surgical management of postoperative infections after the placement of spinal instrumentation in the context of retaining the instrumentation.

Summary Of Background Data: The implementation of spinal instrumentation for the treatment of various spinal conditions is associated with a risk of developing a postoperative wound infection.

Experimental inoculation of raccoons (Procyon lotor) with Spiroplasma mirum and transmissible mink encephalopathy (TME).

The primary objective of this study was to determine whether or not Spiroplasma mirum would be capable of producing lesions of transmissible spongiform encephalopathy (TSE) when inoculated in raccoons (Procyon lotor) and, if that was possible, to compare the clinicopathological findings with those of transmissible mink encephalopathy (TME) in the same experimental model. For this purpose, 5 groups (n = 5) of raccoon kits were inoculated intracerebrally with either S. mirum and/or TME.

Emerging technology in intracranial neuroendoscopy: application of the NICO Myriad.

Improvement in fiber optics and imaging paved the way for tremendous advancements in neuroendoscopy. These advancements have led to increasingly widespread use of the endoscope in neurosurgical procedures, which in turn incited a technological revolution leading to new approaches, instruments, techniques, and a diverse armamentarium for the treatment of a variety of neurosurgical disorders. Soft-tissue removal is often a rate-limiting aspect to endoscopic procedures, especially when the soft tissue is dense or fibrous.

Human auditory cortical activation during self-vocalization.

During speaking, auditory feedback is used to adjust vocalizations. The brain systems mediating this integrative ability have been investigated using a wide range of experimental strategies. In this report we examined how vocalization alters speech-sound processing within auditory cortex by directly recording evoked responses to vocalizations and playback stimuli using intracranial electrodes implanted in neurosurgery patients.

Clinical significance of positive cranial bone flap cultures and associated risk of surgical site infection after craniotomies or craniectomies.

Object: The risk of surgical site infection (SSI) after craniotomies or craniectomies in patients in whom contaminated bone flaps have been reimplanted has not been determined. The objectives of this study were to identify the prevalence of bone flaps with positive cultures--especially those contaminated with Propionibacterium acnes--to assess the risk of SSI after reimplanting (either during the initial operation or subsequently) bone flaps with positive cultures, and to identify risk factors for SSI following the initial craniotomies or craniectomies.

Methods: The authors conducted a retrospective review of cases in which patients underwent craniotomy/craniectomy procedures between January and October 2007 in the neurosurgery department at the University of Iowa Hospitals and Clinics.

Bronchial carcinoma in a red-shouldered hawk (Buteo lineatus).

Respiratory neoplasms are rare in birds. This report describes carcinoma of the bronchial epithelium in a red-shouldered hawk (Buteo lineatus) that presented with weakness and lethargy lasting 4 days that progressed to seizures. Grossly, the caudal air sac and coelomic cavity contained approximately 15 ml of dark brown cloudy fluid that displaced the intestines cranially.

Neurosurgery resident leadership development: an innovative approach.

A great deal of time and resources go into the development and training of neurosurgeons. One area that has minimal literature and assessment is leadership development. Under the core competency of interpersonal and communication skills, the Accreditation Council for Graduate Medical Education has indicated that residents are expected to work effectively as a member or leader of a healthcare team.

Minimally invasive surgery (endonasal) for anterior fossa and sellar tumors.

The primary goal of any surgical approach is to adequately visualize and treat the pathologic condition with minimal disruption to adjacent normal anatomy. The work of several researchers has revealed the promise of minimally invasive endonasal neurosurgery and paved the way for broader applications of the technology. This article discusses the current state of minimally invasive endonasal techniques to address the pathologic conditions of the anterior cranial fossa and parasellar region.

Identification of an amino acid domain encoded by the capsid gene of porcine circovirus type 2 that modulates intracellular viral protein distribution during replication.

Previous work showed that distinct amino acid motifs are encoded by the Rep, Cap and ORF3 genes of two subgroups of porcine circoviruses (PCV), PCV2a and PCV2b. At a specific location of the gene, a certain amino acid residue or sequence is preferred. Specifically, two amino acid domains located in the capsid protein, designated motif-1 (six residues located at positions 86-91) and motif-2 (four residues at positions 190-191-206-210), have been identified to associate with either PCV2a (motif-1a:T(N)KI(S)I and motif-2a:SRKD) or PCV2b (motif-1b:S(N)PR(S)V and motif-2b:AGIE) preferentially.

Cartilaginous metaplasia in the sclera of Suffolk sheep.

Scleral cartilaginous metaplasia was detected by routine histologic examination of globes from 5 Suffolk sheep from a scrapie pathogenesis study. The extent of the metaplasia varied among the sheep but was always posterior to the tapetal fundus. The matrix surrounding chondrocytes stained intensely with alcian blue and was immunopositive for type II collagen.

Treatment of paraneoplastic neurologic disorders.

Paraneoplastic neurologic disorders are rare, autoimmune disorders, which can be broken down into two groups: those in which antibody response is directed against intracellular neuronal or neuroglial proteins (Group 1) and those in which the immune response is directed against antigens within or subjacent to the neuronal cell membrane (Group 2). In both groups, detection and treatment of the underlying neoplasm is critical and carries the best chance of clinical stabilization or remission.Syndromes in Group 2 frequently respond to therapy.

Purkinje cell death after uptake of anti-Yo antibodies in cerebellar slice cultures.

Paraneoplastic cerebellar degeneration accompanying gynecological and breast cancers is characteristically accompanied by a serum and cerebrospinal fluid (CSF) antibody response, termed "anti-Yo," which reacts with cytoplasmic proteins of cerebellar Purkinje cells. Because these antibodies interact with cytoplasmic rather than cell surface membrane proteins, their role in causing Purkinje cell death has been questioned. To address this issue, we studied the interaction of anti-Yo antibodies with Purkinje cells in slice (organotypic) cultures of rat cerebellum.

Chiari malformation Type I in children younger than age 6 years: presentation and surgical outcome.

Object: The authors conducted a study to evaluate the unique presenting signs and symptoms of Chiari malformation Type I (CM-I) in children younger than 6 years of age and highlight the benefits of early surgical treatment in this patient population.

Methods: The authors reviewed the medical records of patients who presented to the neurosurgery department before their 6th birthday and subsequently underwent surgery for CM-I. They identified 39 patients who had been evaluated between 1984 and 2007 and examined the medical records for presentation, surgical intervention, and outcome.

Detection of the abnormal isoform of the prion protein associated with chronic wasting disease in the optic pathways of the brain and retina of Rocky Mountain elk (Cervus elaphus nelsoni).

Eyes and nuclei of the visual pathways in the brain were examined in 30 Rocky Mountain elk (Cervus elaphus nelsoni) representing 3 genotypes of the prion protein gene PRNP (codon 132: MM, ML, or LL). Tissues were examined for the presence of the abnormal isoform of the prion protein associated with chronic wasting disease (PrP(CWD)). Nuclei and axonal tracts from a single section of brain stem at the level of the dorsal motor nucleus of the vagus nerve were scored for intensity and distribution of PrP(CWD) immunoreactivity and degree of spongiform degeneration.

Antineuronal autoantibodies in paraneoplastic cerebellar degeneration associated with adenocarcinoma of the prostate.

Paraneoplastic neurological syndromes are unusual in prostatic cancer, and paraneoplastic cerebellar degeneration associated with adenocarcinoma of the prostate is rare. Here we report a 68year old man who developed progressive ataxia in the setting of stage D2 adenocarcinoma of the prostate and whose MRI showed cerebellar atrophy. The patient's serum produced a previously undescribed pattern of immunoreactivity, binding to nuclei and cytoplasm of Purkinje cells, deep cerebellar neurons, scattered cells in the molecular and granule cell layers, and neuronal populations in thalamus, cerebral cortex, and hippocampus but not with liver or kidney.

Prevention of intrathecal baclofen withdrawal syndrome: successful use of a temporary intrathecal catheter.

Abrupt cessation of intrathecal baclofen (ITB) administration can cause a life-threatening withdrawal syndrome that requires prompt diagnosis and urgent treatment. The current therapy for this condition is administration of propofol, benzodiazepines, paralytics and supportive care. This study reports a 53-year-old patient with paraplegia with an ITB infusion who presented with an infected pump site.

Cerebellar Purkinje cells incorporate immunoglobulins and immunotoxins in vitro: implications for human neurological disease and immunotherapeutics.

Background: Immunoglobulin G (IgG) antibodies reactive with intracellular neuronal proteins have been described in paraneoplastic and other autoimmune disorders. Because neurons have been thought impermeable to immunoglobulins, however, such antibodies have been considered unable to enter neurons and bind to their specific antigens during life. Cerebellar Purkinje cells - an important target in paraneoplastic and other autoimmune diseases - have been shown in experimental animals to incorporate a number of molecules from cerebrospinal fluid.