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Marsha J. Merrill and Edward H. Oldfield

toxicity may limit the therapeutic use of these vectors in the brain. Vascular Endothelial Growth Factor in Nontumoral CNS Disorders The possible contribution of VEGF overexpression to CNS disease has been most extensively studied in the tumor setting. Marked upregulation of VEGF (often demonstrated by immunohistochemistry) has also been observed in human pathological specimens obtained in disorders unrelated to tumors, such as traumatic injury, 150, 161 stroke, 72 aneurysms, 153 subdural hematomas, 169, 177 Alzheimer disease, 77, 138 and AVMs (discussed

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Bruce Rosenblum, Edward H. Oldfield, John L. Doppman, and Giovanni Di Chiro

patients with dural AV fistulas. Three patients with dural AV fistulas and one patient with an intramedullary AVM were reported to have normal myelograms. None of the patients who underwent myelography at the NIH had a normal study. Associated vascular anomalies at other sites (that is, additional vascular malformations and extraspinal aneurysms) occurred in 19% of the patients with intradural malformations and in none of the patients with dural AV fistulas ( Table 7 ). TABLE 7 Associated vascular malformations in each patient group

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Edward H. Oldfield, Andrew Bennett III, Michael Y. Chen, and John L. Doppman

exhibited a spastic, ataxic, broad-based gait with dysmetric motions of the lower extremities. Loss of proprioceptive control was indicated by a positive Romberg sign. The lower extremities were hyperreflexic with Babinski responses bilaterally. 31 y A spinal arteriogram demonstrated an aortic aneurysm and obstruction of the orifice of multiple lumbar arteries due to extensive atherosclerosis, although no vascular abnormality was visualized. Magnetic resonance imaging yielded equivocal results. Repeated myelography revealed dilated tortuous vessels of the coronal venous

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Ryszard M. Pluta, Edward H. Oldfield, and Robert J. Boock

M ore than 28,000 Americans suffer from subarachnoid hemorrhage (SAH) caused by a ruptured intracranial aneurysm each year. 13 Severe spasm of the cerebral arteries, which can be seen on arteriography, often develops 4 to 9 days after SAH 27 and is almost the exclusive cause of the late occurrence of morbidity or mortality in otherwise successful treatment of intracranial aneurysm. 5, 12 Despite intensive research spanning more than 40 years, the etiology of cerebral vasospasm is poorly understood, and there is no successful targeted treatment for it

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Edward H. Oldfield, Robert J. Plunkett, William A. Nylander Jr., and William F. Meacham

temporary aortic occlusion. The incidence with abdominal aortic aneurysms and coarctation of the aorta is low, 13, 41, 46 but intraoperative paraplegia occurs in 5% to 18% of aneurysms involving the thoracic aorta. 2–4, 13 Several experimental methods have been utilized to minimize ischemic spinal cord damage, including hypothermia, 30 drainage of cerebrospinal fluid, 27 bypass of the occluded segment of aorta, 2, 47 and pharmacological measures. 18 Currently, only the various bypass procedures are used clinically, and, although damage to organs beyond the cross

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Joshua M. Ammerman, Russell R. Lonser, and Edward H. Oldfield

intracranial lesions was initially popularized by Drake 4 as a technique for accessing the anterior region of the brainstem to treat basilar artery aneurysms. Subsequent modifications of the anterior subtemporal approach have been used to reach lesions of the lateral and posterolateral brainstem, as well as lesions of the tentorial notch. 4, 12, 13, 19 We describe the surgical technique that we used, the intraoperative findings, and the outcomes of surgery in patients with tumors of the anteromedial superior cerebellum in whom resection was performed using a posterior

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Gregory R. Criscuolo, Edward H. Oldfield, and John L. Doppman

blood supply to the spinal cord and the AVM are thought to predispose the spinal cord to chronic ischemia resulting from arterial steal. Acute neurological deterioration may be due to spontaneous hemorrhage from aneurysms or vessels of the AVM. Venous congestion, arachnoiditis, and cord compression by aneurysmal blood vessels have also been considered potential mechanisms of cord injury in these patients. In contrast to the intramedullary AVM's of the spinal cord, dural AV fistulas are low-flow extramedullary lesions. Dural AV fistulas drain intradurally into the

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John K. B. Afshar, John L. Doppman, and Edward H. Oldfield

acute and subacute myelopathy in patients with dural arteriovenous fistulas: Foix-Alajouanine syndrome reconsidered. J Neurosurg 70: 354–359, 1989 6. Di Chiro G , Doppman JL , Ommaya AK : Selective arteriography of arteriovenous aneurysms of spinal cord. Radiology 88 : 1067 – 1077 , 1967 Di Chiro G, Doppman JL, Ommaya AK: Selective arteriography of arteriovenous aneurysms of spinal cord. Radiology 88: 1067–1077, 1967 7. Doppman JL , Di Chiro G , Oldfield EH : Origin of spinal

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Brian A. Iuliano, Ryszard M. Pluta, Carla Jung, and Edward H. Oldfield

vasodilation. 2, 6, 17, 24, 27, 35, 40, 43, 56, 67 Our objective in this study was to assess in vivo endothelium-dependent vascular relaxation in response to acetylcholine, histamine, and bradykinin, which act via their own receptors, and to Calcimycin (a calcium ionophore that leads to an increase in intracellular calcium levels) in a primate model of cerebral vasospasm. This model most accurately reproduces the post-SAH events that occur in humans, including the time course of delayed vasospasm after bleeding from a ruptured intracranial aneurysm. 5, 9, 14 To achieve

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Walter A. Hall, Edward H. Oldfield, and John L. Doppman

malformations of the spinal cord: assessment using MR. Radiology 156 : 689 – 697 , 1985 Di Chiro G, Doppman JL, Dwyer AJ, et al: Tumors and arteriovenous malformations of the spinal cord: assessment using MR. Radiology 156: 689–697, 1985 8. Di Chiro G , Doppman JL , Ommaya K : Selective arteriography of arteriovenous aneurysms of spinal cord. Radiology 88 : 1065 – 1077 , 1967 Di Chiro G, Doppman JL, Ommaya K: Selective arteriography of arteriovenous aneurysms of spinal cord. Radiology 88: 1065–1077, 1967