Cerebral edema, mass effects, and regional blood volume in man

1977 ◽  
Vol 46 (3) ◽  
pp. 282-289 ◽  
Author(s):  
Richard D. Penn ◽  
Diane Kurtz
Keyword(s):  
Blood Volume ◽  
Cerebral Edema ◽  
Regional Differences ◽  
Ct Scans ◽  
Pressure Gradients ◽  
Content Type ◽  
Local Reduction ◽  
Regional Blood Volume ◽  
Mass Lesions ◽  
The Brain

✓ The authors conducted quantitative analysis of computerized tomography (CT) scans to measure tumor size, cerebral edema, and regional blood volume in man. Mass lesions without edema caused a local reduction in blood volume. Cerebral edema also reduced blood volume in proportion to its severity. Consideration of the electrolyte changes and water shifts in white-matter edema suggested that the decrease in absorption coefficient seen in CT scans was due to the increase in water content. Thus, in cerebral edema separation of blood vessels as well as increased interstitial pressure decrease blood volume, and the regional differences in turn reflect pressure gradients within the brain.

Bifrontal decompressive craniotomy for massive cerebral edema

1971 ◽  
Vol 34 (4) ◽  
pp. 488-493 ◽  
Author(s):  
Raymond N. Kjellberg ◽  
Alberto Prieto
Keyword(s):  
Cerebral Edema ◽  
Massachusetts General Hospital ◽  
Pseudotumor Cerebri ◽  
Toxic Encephalopathy ◽  
Brain Swelling ◽  
High Mortality Risk ◽  
Content Type ◽  
Decompressive Craniotomy ◽  
Post Traumatic ◽  
Mass Lesions

✓ A large bifrontal craniotomy was used in selected patients judged to carry an unusually high mortality risk due to brain swelling secondary to brain trauma. The procedure enabled exploration of both hemisphere convexities, evacuation of accumulated blood and necrotic brain, and decompression of swollen brain. This report reviews 73 cases operated on at the Massachusetts General Hospital since March, 1962; 18% of these patients survived. The largest experience was with post-traumatic cerebral edema, although intractable edema secondary to mass lesions, hemorrhage, toxic encephalopathy, and pseudotumor cerebri was also treated.

Intraoperative identification of motor areas of the rhomboid fossa using direct stimulation

1993 ◽  
Vol 79 (3) ◽  
pp. 393-399 ◽  
Author(s):  
Christian Strauss ◽  
Johann Romstöck ◽  
Christopher Nimsky ◽  
Rudolf Fahlbusch
Keyword(s):  
Brain Stem ◽  
Fourth Ventricle ◽  
Complete Removal ◽  
Direct Stimulation ◽  
Content Type ◽  
Rhomboid Fossa ◽  
Stem Lesions ◽  
Mass Lesions ◽  
The Brain ◽  
Motor Areas

✓ Intraoperative electrical identification of motor areas within the floor of the fourth ventricle was successfully carried out in a series of 10 patients with intrinsic pontine lesions and lesions infiltrating the brain stem. Direct electrical stimulation was used to identify the facial colliculus and the hypoglossal triangle before the brain stem was entered. Multichannel electromyographic recordings documented selective stimulation effects. The surgical approach to the brain stem was varied according to the electrical localization of these structures. During removal of the lesion, functional integrity was monitored by intermittent stimulation. In lesions infiltrating the floor of the fourth ventricle, stimulation facilitated complete removal. Permanent postoperative morbidity of facial or hypoglossal nerve dysfunction was not observed. Mapping of the floor of the fourth ventricle identifies important surface structures and offers a safe corridor through intact nervous structures during surgery of brain-stem lesions. Reliable identification is particularly important in mass lesions with displacement of normal topographical anatomy.

Tumor volume, luxury perfusion, and regional blood volume changes in man visualized by subtraction computerized tomography

1976 ◽  
Vol 44 (4) ◽  
pp. 449-457 ◽  
Author(s):  
Richard D. Penn ◽  
Randal Walser ◽  
Diane Kurtz ◽  
Laurens Ackerman
Keyword(s):  
Blood Volume ◽  
Tumor Volume ◽  
Contrast Material ◽  
Vascular Changes ◽  
Volume Changes ◽  
Cerebral Disease ◽  
Content Type ◽  
Diagnostic Potential ◽  
Luxury Perfusion ◽  
Regional Blood Volume

✓ Computer and photographic methods for producing subtractions of computerized axial tomographic (CAT) scans have been developed. By subtracting point for point a normal scan from one taken after intravenous infusion of contrast material, a picture of the contrast in the cerebral vessels is created. By this method, tumor size and degree of vascularity may be assessed. Furthermore, abnormalities in perfusion and changes in blood volume due to mass effects and edema may be detected. Subtracting scans should add to the diagnostic potential of CAT and provide a noninvasive way to study vascular changes in cerebral disease.

Nasal glioma

1977 ◽  
Vol 46 (1) ◽  
pp. 85-91 ◽  
Author(s):  
Leonard F. Hirsh ◽  
Sylvan E. Stool ◽  
Thomas W. Langfitt ◽  
Luis Schut
Keyword(s):  
Surgical Approach ◽  
Clinical Characteristics ◽  
Neural Tissue ◽  
Surgical Removal ◽  
Content Type ◽  
Nasal Tumors ◽  
Mass Lesions ◽  
The Brain ◽  
Selection Of ◽  
Fine Print

✓ Six cases of nasal gliomas, which are rare ectopic rests of neural tissue found at the root of the nose, are presented. It is important to distinguish nasal tumors from basofrontal encephaloceles to avoid inadvertent exposure of the brain during the surgical removal of mass lesions. Because of their related embryologic origins, the distinction between nasal gliomas and basofrontal encephaloceles may not be clear clinically. Nasal gliomas may be treated by several surgical specialties, and only a proper awareness of their relationship to encephaloceles can assure the selection of a flexible and adequate surgical approach. This paper emphasizes the salient clinical characteristics of nasal gliomas, their clinical distinction from and embryologic relationship to encephaloceles, and the options for treatment.

Progressive ventricular enlargement in cats in the absence of transmantle pressure gradients

1987 ◽  
Vol 67 (1) ◽  
pp. 88-92 ◽  
Author(s):  
Kenneth Shapiro ◽  
Ira J. Kohn ◽  
Futoshi Takei ◽  
Corinna Zee
Keyword(s):  
Brain Tissue ◽  
Subarachnoid Space ◽  
Pressure Gradients ◽  
Content Type ◽  
Cisterna Magna ◽  
Sagittal Sinus ◽  
Intracisternal Injection ◽  
The Mean ◽  
The Brain ◽  
Fine Print

✓ Intracranial pressure (ICP) was measured simultaneously at multiple sites in cats to determine if transmantle pressure gradients were present in progressive hydrocephalus. The cats underwent craniectomy and intracisternal injection of kaolin; 4 to 9 weeks later ICP was measured at the ventricle, cisterna magna, and convexity subarachnoid space, and in the brain tissue and the sagittal sinus. In 13 cats in which ventricular size conformed to previously established norms for duration of hydrocephalus, there were no demonstrable gradients of pressure at any of the sites of measurement according to one-way analysis of variance (p > 0.05). The mean (± standard error of the mean) peak and trough pressures (in mm Hg) at each site were: ventricle, 12.7 ± 0.7 and 12.0 ± 0.6; cisterna magna, 12.9 ± 0.8 and 12.3 ± 0.7; subarachnoid space, 12.7 ± 0.8 and 12.1 ± 0.7; brain tissue, 12.9 ± 0.9 and 12.4 ± 0.9; and sagittal sinus, 13.1 ± 0.8 and 11.9 ± 0.8. These results indicate that ventricular expansion can progress without measurable transmantle pressure gradients.

Late pseudotumoral brain necrosis following irradiation of a scalp neoplasm

1976 ◽  
Vol 45 (5) ◽  
pp. 581-584 ◽  
Author(s):  
Luciano de S. Queiroz ◽  
Joaquim N. da Cruz Neto
Keyword(s):  
Gastrointestinal Bleeding ◽  
Intracranial Hypertension ◽  
Temporal Lobe ◽  
Basal Cell ◽  
Cerebral Edema ◽  
Histopathological Diagnosis ◽  
Content Type ◽  
Basal Cell Epithelioma ◽  
The Brain ◽  
Fine Print

✓ The authors report the case of a 70-year-old man who developed intracranial hypertension and left-arm paresis 2 years after irradiation for a right preauricular basal cell epithelioma. Angiography disclosed a right temporal lobe mass and the histopathological diagnosis was late postirradiation necrosis of the brain. Postoperatively, dexamethasone was given in increasing doses up to 60 mg/day for control of cerebral edema. The patient died of gastrointestinal bleeding on the 60th postoperative day.

Civilian gunshot wounds of the brain

1978 ◽  
Vol 49 (2) ◽  
pp. 185-198 ◽  
Author(s):  
Joel B. Kirkpatrick ◽  
Vincent Di Maio
Keyword(s):  
Brain Stem ◽  
Cerebral Edema ◽  
High Velocity ◽  
Soft Tissues ◽  
Gunshot Wounds ◽  
Large Percentage ◽  
Low Velocity ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ The authors report on 42 fatal gunshot wounds to the brain in civilians. The firearms used were those commonly available to civilians, ranging from a .22 revolver to a .45 semiautomatic pistol. Missile tracks were measured and the volume computed. The relatively low-velocity missiles produced by these weapons do not create the devastation that characterizes wounds from high-velocity military firearms. Instead, there is much variation in the size of the missile tracks, and they cannot be directly related to caliber. Pressure marks and contusions, impaction of bone chips, internal ricochet, and cerebral edema occurred frequently. The missile passed through the brain completely in every case but was retained by the skull or soft tissues in a large percentage of cases. The mechanism of death may be acute pressure on the brain stem from the passage of the missile through the brain.

Thrombosed arteriovenous malformations of the brain

1982 ◽  
Vol 57 (4) ◽  
pp. 520-526 ◽  
Author(s):  
Robert E. Wharen ◽  
Bernd W. Scheithauer ◽  
Edward R. Laws
Keyword(s):  
Arteriovenous Malformations ◽  
Previous History ◽  
Low Grade ◽  
Spontaneous Thrombosis ◽  
Radiographic Findings ◽  
Content Type ◽  
Seizure Disorders ◽  
History Of ◽  
Mass Lesions ◽  
The Brain

✓ Thrombosed arteriovenous malformations (AVM's) in patients with no previous history of hemorrhage are uncommon but benign lesions that present with clinical and radiographic findings which are often indistinguishable from those of other mass lesions, particularly low-grade gliomas. The authors report seven cases of thrombosed AVM's presenting as intractable seizure disorders in which the radiographic studies had suggested a low-grade glioma. All seven patients are now seizure-free 2 to 40 months postoperatively. The importance of surgical exploration in the management of such patients is emphasized. A review of 32 cases reported in the literature is presented. The reasons why angiography may fail to demonstrate an AVM, and the possible etiologies for the spontaneous thrombosis of an AVM are discussed.

Regional differences in erythrocyte transit in normal lungs

1985 ◽  
Vol 59 (4) ◽  
pp. 1266-1271 ◽  
Author(s):  
J. C. Hogg ◽  
B. A. Martin ◽  
S. Lee ◽  
T. McLean
Keyword(s):  
Blood Volume ◽  
Transit Time ◽  
Regional Differences ◽  
Regional Blood Flow ◽  
Mean Transit Time ◽  
Vascular Bed ◽  
Transit Times ◽  
Regional Blood Volume ◽  
The Relationship ◽  
Normal Lungs

We measured regional blood volume and flow in the lungs of nine mongrel dogs. The time taken for the erythrocytes to transit through individual lung regions was calculated from the relationship t = V/Q, where V is blood volume and Q is flow. The data show that the total pulmonary blood volume was 82 +/- 6 ml and that the average time spent in the pulmonary vascular bed was 2.86 +/- 0.31 s. The frequency distribution of the transit times ranged from 0.41 to 6 s in the experiment with the shortest mean transit (1.62 s) and from 0.9 to greater than 20 s in the experiment with the longest mean transit time (4.6 s). The regional data show that the longer transit times were in the upper lung and that expansion of the blood volume as flow increased down the lung prevented an excessive shortening of the transit time. We conclude that increasing regional blood flow is associated with an expansion of regional blood volumes so that the transit times remain relatively constant.

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