Metabolic aspects of myocardial disease and a role for L-carnitine in the treatment of childhood cardiomyopathy.

Objectives: A multicenter retrospective study was conducted to investigate the possible metabolic causes of pediatric cardiomyopathy and evaluate the outcome of patients treated with L-carnitine.

Methods: Seventy-six patients diagnosed with cardiomyopathy were treated with L-carnitine in addition to conventional cardiac treatment, and 145 patients were treated with conventional treatment only. There were 101 males and 120 females between 1 day and 18 years old.

A methodology designed to increase accuracy and safety in stereotactic brain surgery.

A series of technical tips and devices designed to increase accuracy and safety in stereotactic surgery are presented. We use stereotactic magnetic resonance imaging with three-dimensional magnetization-prepared rapid gradient-echo (MP-RAGE) imaging to minimize image distortion, and a three-dimensional stereotactic planning system for accurately registering three-dimensional space. We also developed several technical devices useful for stereotactic intracranial procedures; an applicator system attached to the frame which simulates the fiducial markers in order to keep the target at a suitable position in stereotactic space; a torque wrench to set the torque on the fixing pins to the frame reproducibly at 5 inch pounds in order to keep distortion of the frame to a minimum while maintaining secure fixation; an entry point marker to maintain the calculated trajectory angle; a straightening cannula to prevent the thermo-coagulation needle from bending; a microvascular Doppler and its holder to detect significant vessels and to know their precise depth in order to avoid vascular injury from thermocoagulation; a burr hole button device to secure depth electrode cables at the patient's skull.

Occipital atrophy is associated with visual hallucinations in Alzheimer's disease.

In this study of patients with Alzheimer's disease (AD), patients with visual hallucinations were compared with patients who did not have visual hallucinations to determine if selective occipital lobe atrophy is associated with visual hallucinations. Seven AD patients with visual hallucinations were matched by cognitive score to 7 AD patients without visual hallucinations and 3-D MRI images obtained. A ratio of measured occipital volumes to whole brain volumes was compared between the two groups.

An accurate adjustable applicator for magnetic resonance imaging-based stereotactic procedure using the Leksell G frame.

Objective: An applicator system for the Leksell G frame was constructed to enable accurate placement of the frame for stereotactic magnetic resonance imaging (MRI) and successful stereotactic surgery. The applicator prevents inaccurate placement of the fiducial box on the patient's head and prevents contact of the frame holder with the patient's shoulder while in the MRI unit. It also helps to ensure optimal positioning of desired targets within the three-dimensional stereotactic space defined by the frame.

Double-blind, randomized, vehicle-controlled study of high-dose tirilazad mesylate in women with aneurysmal subarachnoid hemorrhage. Part II. A cooperative study in North America.

Object: To test the safety and efficacy of high-dose (15 mg/kg/day) tirilazad mesylate in women suffering from aneurysmal subarachnoid hemorrhage (SAH), a prospective randomized, double-blind, vehicle-controlled trial (parallel to the one conducted in Europe, Australia, New Zealand, and South Africa) was performed at 65 North American neurosurgical centers.

Methods: Of the 832 patients who were randomized, 823 received at least one dose of tirilazad (410 patients) or placebo vehicle containing citrate (413 patients). The two groups were similar with respect to their prognostic factors for overall outcome and delayed cerebral ischemia.

Double-blind, randomized, vehicle-controlled study of high-dose tirilazad mesylate in women with aneurysmal subarachnoid hemorrhage. Part I. A cooperative study in Europe, Australia, New Zealand, and South Africa.

Object: Findings from previous multicenter clinical trials have suggested that tirilazad mesylate, a synthetic nonhormonal 21-aminosteroid, might be effective in preventing delayed cerebral ischemia following subarachnoid hemorrhage (SAH). This beneficial effect, however, was greater in males than females, possibly because of gender-related pharmacokinetic differences. The authors sought to assess the effects of administering a larger dose of tirilazad in women with SAH.

Monoclonal antibodies against ICAM-1 and CD18 attenuate cerebral vasospasm after experimental subarachnoid hemorrhage in rabbits.

Background And Purpose: Inflammatory responses have been implicated in the elaboration of several forms of central nervous system injury, including cerebral vasospasm after subarachnoid hemorrhage (SAH). A critical event participating in such responses is the recruitment of circulating leukocytes into the inflammatory site. Two of the key adhesion molecules responsible for the attachment of leukocytes to endothelial cells are intercellular adhesion molecule-1 (ICAM-1) and the common beta chain of the integrin superfamily (CD18).

Neurosurgery at the University of Virginia.

Before 1937, members of the Department of Surgery and Gynecology practiced emergency neurosurgery at the University of Virginia in the same fashion as in other hospitals in the United States. In 1937, Claude C. Coleman, Chairman of the Department of Neurosurgery at the Medical College of Virginia in Richmond, organized a Division of Neurosurgery as part of the Department of Surgery and Gynecology at the University of Virginia.

Intracranial dissecting aneurysm causing subarachnoid hemorrhage: the role of computerized tomographic angiography and magnetic resonance angiography.

Background: With increasing frequency, dissecting aneurysms of the intracranial arteries are recognized as a possible cause of subarachnoid hemorrhage (SAH). In the presence of a dissecting aneurysm, angiographic changes may be subtle at presentation and correct diagnosis often requires serial angiograms. We report a patient with a dissecting aneurysm of the anterior cerebral artery (ACA) causing SAH, in whom less invasive diagnostic tools, such as high-resolution computerized tomographic angiography (CTA) and magnetic resonance angiography (MRA), were helpful in confirming the diagnosis and in following the evolution of the dissection.

Acquired lumbar stenosis: topic review and a case series.

Stenosis of the central and lateral lumbar vertebral canal can be congenital or acquired; the latter is most often caused by a degenerative process. The associated neurogenic claudication and/or radiculopathic symptom complexes are thought to result from compression of the cauda equina and lumbosacral nerve roots by hypertrophy of or encroachment by any combination of the following: canal walls, ligamenta flava, intervertebral discs, posterior longitudinal ligament, or epidural fat. The authors' technique for the treatment of lumbar stenosis involves extensive unilateral decompression with undercutting of the spinous process and obviates the need for instrumentation by using a contralateral autologous bone fusion.

Recovery of useful hearing after posterior fossa surgery: the role of otoacoustic emissions: case report.

Objective And Importance: Hearing preservation has become an important issue in surgical procedures involving the cerebellopontine angle (CPA). Although several prognostic factors for hearing preservation in patients with "useful" preoperative hearing have been described, it is difficult to predict which patients have the potential for hearing preservation or recovery. Otoacoustic emission measurement is a new technique that allows recording of sounds produced by the cochlear outer hair cells as a normal byproduct of the receptor process and can be used to assess cochlear involvement in patients with hearing loss.

A burr hole button to secure the electrode cable in depth electrode placement. Technical note.

A simple magnetic resonance imaging-compatible buttonlike device was devised to fix a depth electrode cable securely in the burr hole used for its insertion during surgery for depth electrode placement. The button is tightly fixed in the burr hole and it holds the cable without allowing protrusion or tension on the wound.

Long-term outcome after surgical excision of parenchymal arteriovenous malformations in patients over 60 years of age.

Background: Age is considered an important limiting factor for surgical excision of parenchymal arteriovenous malformations (AVMs) and a more conservative therapeutic approach has been advocated in the elderly. There are no studies available investigating the long-term outcome after surgical excision of parenchymal AVMs in patients over 60 years of age.

Methods: We report the surgical outcome after excision of an AVM in a series of 13 consecutive patients older than 60 years.

Attenuation of ischemia-reperfusion injury in the rat neocortex by the hydroxyl radical scavenger nicaraven.

Objective: Oxygen free radicals are considered important contributors to cerebral ischemia-reperfusion injury. The purpose of this study was to examine the effects of the hydroxyl radical scavenger, (+/-)-N, N'-propylenedinicotinamide (nicaraven), on cerebral injury after focal ischemia-reperfusion.

Methods: A total of 58 male Sprague-Dawley rats was subjected to transient focal ischemia by occluding both carotid arteries and one middle cerebral artery for 3 hours.

Intraischemic hypothermia attenuates neutrophil infiltration in the rat neocortex after focal ischemia-reperfusion injury.

Objective: The mechanisms by which hypothermia influences postischemic outcome remain a matter of discussion. One mechanism thought to play an important role in neuronal damage after ischemia/reperfusion is the accumulation of polymorphonuclear leukocytes in compromised brain tissue. To better understand the potential impact of hypothermia on this injurious mechanism, the present study examined the effect of intraischemic hypothermia on polymorphonuclear leukocyte accumulation after transient focal ischemia.

Ethical considerations in clinical neuroscience. Current concepts in neuroclinical trials.

Background: Ethical decision making in clinical trials has become increasingly emphasized at many levels of the review process.

Summary Of Review: Ethical concepts applicable to neuroclinical trials are reviewed. The discussion is directed toward ethical concerns that investigators must consider and justify prior to institutional review board submission.

Maturation of intracranial immature teratomas. Report of two cases.

Immature teratomas arising within the central neuraxis are rare neoplasms. These tumors contain diverse cell lineages that retain an embryonal character and display phenotypic differentiation attributed to the three classic germ layers. The clinical management of these lesions is unclear, due in part to their low incidence and to an incomplete understanding of their natural history.

Randomized, double-blind, vehicle-controlled trial of tirilazad mesylate in patients with aneurysmal subarachnoid hemorrhage: a cooperative study in Europe, Australia, and New Zealand.

Tirilazad mesylate, a nonglucocorticoid 21-aminosteroid, has been shown in experimental models to reduce vasospasm following subarachnoid hemorrhage (SAH) and to reduce infarct size from focal cerebral ischemia. To test whether treatment with tirilazad would reduce ischemic symptoms from vasospasm and improve overall outcome in patients with ruptured aneurysms, a prospective randomized, double-blind, vehicle-controlled trial was conducted at 41 neurosurgical centers in Europe, Australia, and New Zealand. One thousand twenty-three patients were randomly assigned to receive 0.

Treatment of lumbar spinal stenosis by extensive unilateral decompression and contralateral autologous bone fusion: operative technique and results.

A new surgical technique for the treatment of lumbar spinal stenosis features extensive unilateral decompression with undercutting of the spinous process and, to preserve stability, uses contralateral autologous bone fusion of the spinous processes, laminae, and facets. The operation was performed in 29 patients over a 19-month period ending in December of 1991. All individuals had been unresponsive to conservative treatment and presented with low-back pain in addition to signs and symptoms consistent with neurogenic claudication or radiculopathy.

Stereotactic frame-based error in magnetic-resonance-guided stereotactic procedures: a method for measurement of error and standardization of technique.

When using the stereotactic Leksell G frame for magnetic-resonance-based functional stereotactic lesions, the authors occasionally encountered a situation in which it was not possible to apply the anterior plate of the coordinate box successfully because it came into contact with the anterior posts of the frame; it was noted that the posts as well as the base ring became distorted by the force required to insert the cranial fixation pins. To examine this issue, measurements were taken of the amount of distortion relative to the torque on the screws. It was also found that backward movement of the posterior segment of the base ring indirectly narrowed the anterior spaces for plate insertion.

Accuracy of an experimental stereotactic system for MRI-based gamma knife irradiation in the rat.

Stereotactic devices for experimental Gamma Knife irradiation and magnetic resonance imaging (MRI) have recently been developed for experimental studies using rats [6,7]. The present study examined the accuracy of these devices using the following two approaches. In the first approach, Gamma Knife irradiation was performed using the stereotactic device with targets based on a standard stereotactic atlas.

Occlusion of the anterior cerebral artery after Gamma Knife irradiation in a rat.

The anterior cerebral artery of rats was irradiated at the level of the circle of Willis by Gamma Knife with a maximum dose of 25, 50, or 100 Gy. Occlusion of the anterior cerebral artery was observed in one rat which was followed for 20 months after irradiation of 100 Gy. Cerebral infarction was found at the midline-frontal region and the cingulate gyrus.