Is there a relationship between the extent of tonsillar ectopia and the severity of the clinical Chiari syndrome?

Background: Chiari 1 malformation is diagnosed if the cerebellar tonsils extend at least 5 mm below the opisthion-basion line.

Objective: To examine the correlation of the extent of tonsillar ectopia with the prevalence and severity of the symptoms associated with the Chiari malformation.

Methods: Patients (N = 428) were grouped according to the extent of tonsillar ectopia on the mid-sagittal MRI image (group 1, 0-< 3 mm; group 2, 3-5 mm; group 3, > 5 mm).

Operative findings and surgical outcomes in patients undergoing Chiari 1 malformation decompression: relationship to the extent of tonsillar ectopia.

Background: The diagnosis of Chiari 1 malformation is based on the extent of tonsillar ectopia.

Objective: To examine the relationship between the extent of tonsillar ectopia and the intra-operative findings and clinical outcome following Chiari decompression surgery.

Methods: Patients were divided into four groups depending on the position of the cerebellar tonsil (T): group 1: 0 < T < 3; group 2: 3 ≤ T ≤ 5; group 3: 5 < T ≤ 10; and group 4: T > 10.

A case-control study of cerebellar tonsillar ectopia (Chiari) and head/neck trauma (whiplash).

Primary Objective: Chiari malformation is defined as herniation of the cerebellar tonsils through the foramen magnum, also known as cerebellar tonsillar ectopia (CTE). CTE may become symptomatic following whiplash trauma. The purpose of the present study was to assess the frequency of CTE in traumatic vs non-traumatic populations.

Treatment of cervical myelopathy in patients with the fibromyalgia syndrome: outcomes and implications.

Some patients with fibromyalgia also exhibit the neurological signs of cervical myelopathy. We sought to determine if treatment of cervical myelopathy in patients with fibromyalgia improves the symptoms of fibromyalgia and the patients' quality of life. A non-randomized, prospective, case control study comparing the outcome of surgical (n = 40) versus non-surgical (n = 31) treatment of cervical myelopathy in patients with fibromyalgia was conducted.

Clinical evidence for cervical myelopathy due to Chiari malformation and spinal stenosis in a non-randomized group of patients with the diagnosis of fibromyalgia.

Objective: While patients with fibromyalgia report symptoms consistent with cervical myelopathy, a detailed neurological evaluation is not routine. We sought to determine if patients with fibromyalgia manifest objective neurological signs of cervical myelopathy.

Methods: Two hundred and seventy patients, 18 years and older, who carried the diagnosis of fibromyalgia but who had no previously recognized neurological disease underwent detailed clinical neurological and neuroradiological evaluation for the prevalence of objective evidence of cervical myelopathy and radiological evidence of cerebellar tonsillar herniation (Chiari 1 malformation) or cervical spinal canal stenosis.

The effect of incomplete patient follow-up on the reported results of AVM radiosurgery.

Background: The reported efficacy of AVM radiosurgery--80-85% 2-year obliteration rate--is based exclusively on the results of follow-up arteriography in a small percentage of treated patients; it is therefore inaccurate. We examined the effect of incomplete follow-up on the results of AVM radiosurgery.

Methods: We reviewed the results of AVM radiosurgery in 82 patients after a minimum of 24 months of follow-up.

Stereotactic transsylvian, transinsular approach for deep-seated lesions.

Background: Lesions located deep within the frontal and parietal lobes adjacent to the internal capsule are often considered surgically inaccessible. We have used intraoperative stereotactic lesion localization in conjunction with microsurgical dissection of the lateral sylvian fissure to accurately and atraumatically approach such lesions through the insular cortex.

Methods: When possible, the sylvian fissure is widely opened using standard microsurgical technique.

Acquired spinal cord injury in human fetuses with myelomeningocele.

Experimental studies have shown that there is a potential to attempt in utero repair of myelomeningocele in human fetuses. To provide a better understanding of the pathology of these lesions we prospectively studied eight stillborn human fetuses with myelomeningocele autopsied at The Johns Hopkins Hospital. The intact vertebral column with surrounding structures was removed, processed as a single block, and prepared as serial histologic sections.

Operative confirmation of three-dimensional computed tomographic and magnetic resonance imaging of cerebrovascular pathology.

The conventional neuroradiological evaluation of aneurysms and arteriovenous malformations employs computed tomography (CT), magnetic resonance imaging (MRI), and detailed cerebral angiography. These techniques may be inadequate to define fully the cerebrovascular anatomy in patients with giant aneurysms or with arteriovenous malformations (AVMs) located near so-called eloquent brain structures. Therefore, we examined the usefulness of three-dimensional (3-D) MRI and CT images of the brain and cerebral vessels for predicting operative anatomical findings in selected cases of complex cerebrovascular pathology.

Intrauterine repair of experimental surgically created dysraphism.

The paralysis seen in children with myelomeningocele has been attributed to congenital myelodysplasia. Clinical and pathological data, however, suggest that the paralysis may be due in part to a spinal cord injury caused by exposure of the neural tube to the intrauterine environment. This possibility has been supported by experimental data obtained using a fetal rat model of surgically created dysraphism.

Sustained release of papaverine for the treatment of cerebral vasospasm: in vitro evaluation of release kinetics and biological activity.

Cerebral vasospasm remains an unpredictable and inadequately treated complication of aneurysmal subarachnoid hemorrhage. To date, pharmacological treatment has been plagued in part by an inability to attain sufficiently high concentrations of vasodilator drug in the cerebrospinal fluid without precipitating systemic side effects such as hypotension. To circumvent this limitation of current pharmacological therapy, the authors have developed a sustained-release preparation of papaverine that can be implanted intracranially at the time of surgery for aneurysm clipping.

Pituitary gigantism caused by growth hormone excess from infancy.

A 2 1/4-year-old boy with pituitary gigantism had a large pituitary macroadenoma. Gross tumor removal has prevented further visual losses, but he has had persistent hypersecretion of growth hormone and prolactin. Treatment with somatostatin analog has decreased both hormone secretion and growth velocity.

Cerebrovascular CO2 reactivity during delayed vasospasm in a canine model of subarachnoid hemorrhage.

While the in vitro reactivity of cerebral conducting vessels following subarachnoid hemorrhage has been extensively studied, in vivo cerebrovascular CO2 reactivity has not been systematically investigated. We tested the hypothesis that, in the canine model of subarachnoid hemorrhage, the rise in cerebral blood flow normally seen with hypercapnia is blunted during delayed vasospasm. Four groups of animals were studied: one received two 4-ml subarachnoid injections of nonheparinized arterial blood into the cisterna magna (n = 8), one received three subarachnoid injections of 5 ml blood (n = 5), one received two subarachnoid injections of 4 ml saline (n = 5), and a control group (n = 5) had no subarachnoid injections or angiography.

Osteoblastic metastases from astrocytomas: a report of two cases.

The spread of primary central nervous system (CNS) neoplasms beyond the confines of the neuraxis is a relatively uncommon observation. Extraneural metastases involving bone are quite rare, and have been observed almost exclusively in cases of medulloblastoma, high-grade (III-IV) astrocytoma, and glioblastoma multiforme. To date there has been only one case reported of bone metastasis from a "well-differentiated" astrocytoma.

Surgical resection of intrinsic brain stem lesions: an overview.

A major limitation to the effective treatment of intrinsic mass lesions of the brain stem has been the inability to clearly define the pathological anatomy radiographically. The improved soft tissue resolution offered by magnetic resonance imaging, as compared with axial computed tomography, now makes it possible not only to accurately distinguish anatomical relationships, but also to predict the pathological nature of the lesion. Accordingly, we have been encouraged to pursue a more aggressive approach to intrinsic lesions of the brain stem that appear well circumscribed on magnetic resonance imaging scan.

The paralysis associated with myelomeningocele: clinical and experimental data implicating a preventable spinal cord injury.

Paralysis seen in children with myelomeningocele has been attributed to congenital myelodysplasia. We suspected that paralysis may be due in part to a spinal cord injury caused by exposure of the neural tube to the amniotic fluid. This hypothesis was tested using a fetal rat model of surgically created dysraphism.

Inflammatory intracranial mass lesion: an unusual complication resulting from the use of Gelfoam.

There are few reported complications associated with the use of Gelfoam. We report the case of a 29-year-old woman who developed signs and symptoms of meningeal inflammation and an expanding intracranial mass related to the intracranial use of Gelfoam. Findings were confirmed by surgical exploration.

Insulin and IGF-I stimulate phosphorylation of their respective receptors in intact neuronal and glial cells in primary culture.

Previous studies have shown that insulin and IGF-I bind to their respective receptors and stimulate autophosphorylation of the receptor beta subunits in detergent extracts of neuronal and glial cells. In the present study, intact neuronal and glial cells in primary culture have been utilized to characterize insulin- and IGF-I-stimulated phosphorylation of their receptors. Following [32P]orthophosphate labelling and stimulation by insulin or IGF-I, the cells were solubilized and the phosphorylated receptors were partially purified on wheat germ agglutinin--agarose columns, and immunoprecipitated using anti-phosphotyrosine or anti-insulin receptor antibodies.

Insulin and insulin-like growth factor-I stimulate a common endogenous phosphoprotein substrate (pp185) in intact neuroblastoma cells.

Mouse neuroblastoma N18 cells contain specific high affinity insulin and insulin-like growth factor-I (IGF-I) receptors. Insulin and IGF-I induce phosphorylation, in intact cells, of their respective receptor beta subunits. The insulin receptor beta subunit is represented by a 95-kDa phosphoprotein that is recognized by a specific antiserum (B10).