[Intra- and postoperative cerebral blood flow in patients with subarachnoid hemorrhage from a ruptured aneurysm]. / Flusso ematico cerebrale intra- e postoperatorio in pazienti con emorragia subaracnoidea da fissurazione di aneurisma.

The CBF of eight patients, who underwent surgery for ruptured aneurysm, was monitored using the termodiffusion technique (TDF). The device employed in this investigation allowed a continuous monitoring in "real time" of the cortical flow. The purpose of the study was to detect disorders of autoregulation, which were evaluated with the autoregulation index (AI). Autoregulation was correlated with the neurological preoperative grading, the postoperative changes of CBF (Xe133 clearance) and the outcome. The results of this preliminary study showed a correlation between these parameters and stressed the value of CBF monitoring during surgery.

Neuropsychological evaluation in a series of 17 cases operated on for craniosynostosis.

In a study of patients suffering from craniosynostosis various pre- and post-operative parameters were identified that may affect subsequent intellectual capacity. In particular, facial malformations appeared to be closely correlated with impaired intellectual development. Other parameters included measurement of cranial circumference and volume; their subaverage values correlated with slight mental insufficiency. However, in the pre-operative period they cannot be used as prognostic indices because these relations were statistically not significant. The remaining parameters (neurological and electroencephalographic findings, post-operative re-ossification of the skull, pre-operative digital impressions, CT findings) did not seem to be related to intellectual development.

Changes in infratentorial blood flow following experimental cerebellar haemorrhage. A preliminary report.

The temporal progression of changes in blood flow within the hemispheric cerebellar cortex, following an experimental cerebellar ipsilateral haemorrhage, was investigated in rats by using the hydrogen clearance technique. Stereotactical injection of 50 microliters of fresh autologous blood into the paramedian white matter was found to produce an early drop of cerebellar blood flow, with subsequent rise toward higher values. An increase of the intracranial pressure only occurred at the time of injection of blood. Arterial blood gases, mean arterial blood pressure and blood glucose levels did not exhibit significant changes. Histochemical evaluations of glycogen phosphorylase showed a posthaemorrhagic pattern of enzyme depletion, consistent with the occurrence of an ischaemic damage in both the cerebellum and the brain stem.

Muscle basal lamina as a grafting material for elongation of axons from rat brain.

Autografts of peripheral nerve or allografts of muscle basal lamina were inserted into the putamen-caudate complex of rats, with the outer end of the implant being sutured to the temporalis muscle. Elongation of central axons within the grafts, as revealed by the horseradish peroxidase retrograde labelling technique, did occur in the presence of basal lamina implants. With both types of grafting materials stained neurones exhibited a comparable distribution, being mainly found in the proximity of the central tip of the grafts. However, labelled cells in the presence of basal lamina were limited in number, compared with peripheral nerve autografts. Therefore, the usefulness of implants of muscle basal lamina into the central nervous system, in order to direct regenerating central axons toward distant target regions, is limited. This material might be suitable, as an alternative grafting material, in experimental models where avoidance of neurological impairment or size and length of the graft are crucial factors.

Regional cerebral blood flow after omental transposition to the ischaemic brain in man. A five year follow-up study.

Regional cerebral blood flow, recorded by the 133Xenon inhalation method, was measured preoperatively and over a five years postoperative period in six patients with completed stroke and stabilized neurological deficits, who had undergone omental transposition for revascularization of the ischaemic brain. Comparisons of the preoperative blood flow values with those recorded following surgery demonstrate a postoperative increase of blood flow in five patients, with a high statistical degree of significance in four of them at the final examination. The flow increase was noted over the infarcted areas of the brain, upon which the omentum had been placed, as well as areas of the ischaemic hemisphere without omental placement and the contralateral hemisphere. Out of the five patients who demonstrated preoperative flow values below the expected norm for age, four showed final postoperative cerebral blood flow within the normal limits for their age. The results are consistent with the assumption that the transposed omentum played a role in postoperative blood flow increase, by adding collateral circulation to the ischaemic brain.

Long term follow-up of the surgical treatment of the intracranial hydatid disease.

Long term results of the surgical treatment of intracranial hydatid disease ist reported in 11 personal cases. Nine patients are alive 9 to 15 years following the operation, only one of them being disabled. The remaining two patients died respectively 6 months and 2 years after the first operation.

[Anatomo-surgical classification and surgical treatment of arteriovenous malformations in the posterior cranial fossa]. / Classificazione anatomo-chirurgica e trattamento operatorio delle malformazioni artero-venose della fossa cranica posteriore.

An increasing number of arteriovenous malformations of the posterior cranial fossa can be radically extirpated with good functional results, by using microsurgical techniques. Extensive involvement of the brain stem represents the limit for effective surgery. An anatomo-surgical classification of these lesions is presented, and the surgical indications are discussed.

Cerebral blood flow in minor cerebral contusion.

Seventeen patients with minor cerebral contusion were selected from a series of patients with head injuries of various severity, who had undergone repeat evaluations of the regional cerebral blood flow. The mean global flow (expressed as mean global initial slope index) on early examination was found to be significantly lower, compared with that recorded in healthy volunteers. A tendency towards the recovery of higher flow values was apparent in repeat evaluations that were performed several weeks after the injury. Interhemispheric asymmetries of flow were a common occurrence, with lower perfusion and reduced attenuation values on computed tomography scans being, however, in good agreement only in approximately half of the cases.

Subchoroidal approach to the third ventricle. Microsurgical anatomy.

The third ventricle can be approached by performing a few surgical maneuvers: (a) dividing the ependyma on the inferolateral aspect of the choroid plexus of the lateral ventricle; (b) separating leptomeningeal bundles within the tela chorioidea, and (c) dividing the roof of the third ventricle along the stria medullaris. Main landmarks are the thalamostriate vein and the direct lateral vein. Small subependymal veins or neural branches of the posterior medical choroidal artery, or both, occasionally cross the access route. The third ventricle is seen through both the opening in the roof and the foramen of Monro. A wider exposure can be obtained by cutting the terminal segment of the thalamostriate vein.

Redundant nerve roots of the cauda equina.

The authors have critically reviewed 8 cases which have come under their observation of a lumbosciatic syndrome due to redundant nerve roots of the cauda equina. Some of the clinical and myeloradiculographic features appear to be characteristic of this rare syndrome. Surgical intervention by decompressing the nerve roots of the cauda equina offers a very favourable prognosis.

Omental transposition or transplantation to the brain and superficial temporal artery--middle cerebral artery anastomosis in preventing experimental cerebral ischaemia.

Transposition of lengthened omentum to the brain surface, transplantation of an omental graft, or superficial temporal artery--middle cerebral artery anastomosis were performed in dogs prior to transcranial occlusion of the ipsilateral middle cerebral artery at its origin, including the bifurcation of the internal carotid artery. Both omentum and by-pass were able to reduce the changes in cerebral blood flow, somatosensory evoked responses, cerebral water and electrolyte content, consequent to the ischaemic insult. In the experimental conditions adopted in this study, the effect of omental transposition in maintaining high levels of flow throughout the entire occluded hemisphere was more marked compared to that resulting from the other methods, while the onset of ischaemic cerebral oedema was affected approximately at the same degree by all procedures. The results point to the role of the transposed omentum in providing an effective collateral circulation to the ischaemic brain.

Mobile neurinoma of the cauda equina. Case report.

A mobile neurinoma arising from a redundant nerve root of the cauda equina is reported. The abnormal length of the nerve root allowed the neoplasm to move in the cranio-caudal direction along two segments of the spine.

Reversible contrast-enhanced lesions of basal ganglia and brain stem on computed tomography.

Two cases of reversible CT contrast-enhanced lesions simulating brain neoplasms are described. Following steroid therapy and shunting procedure normalization of the clinical signs and of the CT scans occurred. The role of a vasculomyelinopathy as a possible pathogenetic factor of these lesions is stressed.

Aminoacid incorporation into polyribosomes of ischaemic and reperfused gerbil brain.

Aminoacid incorporation into polyribosomes from the gerbil brain in a cellfree system is strongly affected by experimental ischaemia. Progression of the impairment of the protein synthesis in vitro occurs even following early reperfusion.

Effect of omental transposition to the brain on protein synthesis in experimental cerebral ischaemia.

Occlusion of the middle cerebral artery severely affects the uptake of labelled leucine into various subcellular fractions from rabbit brain. Previous transposition of pedicled omentum to the cerebral surface maintains to a large extent the protein synthetic activity of the brain following arterial occlusion. The role of the transposed omentum in providing an effective collateral circulation and minimizing the occurrence of irreversible ischaemic lesions is stressed.

Remarks on the surgical treatment of the craniosynostoses.

Technical aspects and results of a surgical procedure for craniosynostoses are exposed. Fragmentation-recomposition of the anterior part of the cranial vault in cases of brachi-, acro-, turri- and trigono-cephaly gives both an effective decompression and a satisfactory cosmetic result.