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100 Case Reviews
in Neurosurgery
This page intentionally left blank
100 Case Reviews
in Neurosurgery
RAHUL JANDIAL, MD, PhD
Associate Professor
Division of Neurosurgery, Department of Surgery
City of Hope Cancer Center & Beckman Research Institure
Los Angeles, CA, USA

MICHELE R. AIZENBERG, MD
Associate Professor of Neurological Surgery and Oncology,
Director, Brain and Spine Cancer Center
University of Nebraska Medical Center
Omaha, NE, USA

MIKE Y. CHEN, MD, PhD

Associate Professor
Division of Neurosurgery, Department of Surgery
City of Hope Cancer Center & Beckman Research Institure
Los Angeles, CA, USA
SECTION EDITORS
Henry E. Aryan, MD
Ramsis Benjamin, MD
Justin Brown, MD
Joseph D. Ciacci, MD
Griffith R. Harsh IV, MD
Adam S. Kanter, MD
Aasim S. Kazmi, MD
Alexander A. Khalessi, MD
Paul S. Larson, MD
Michael L. Levy, MD, PhD
Neal Prakash, MD, PhD
J. Dawn Waters, MD

For additional online content visit http://expertconsult.inkling.com

Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2017
© 2017, Elsevier Inc. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
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This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).

Notices

Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical treatment
may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
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information or methods they should be mindful of their own safety and the safety of others, including
parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
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and contraindications. It is the responsibility of practitioners, relying on their own experience and
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To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume
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contained in the material herein.

ISBN: 978-0-323-35637-4

Content Strategist: Charlotta Kryhl

Content Development Specialist: Alexandra Mortimer
Content Coordinator: Devika Ponnambalam
Project Manager: Louisa Talbott
Design: Christian Bilbow
Illustration Manager: Amy Naylor
Marketing Manager: Rachael Pignotti

Printed in China

Last digit is the print number: 9 8 7 6 5 4 3 2 1

 Contents

Preface xii
List of Contributors xiii
Acknowledgments xxii
Dedication xxiii

SECTION I
Vascular Neurosurgery
Section Editor: Alexander A. Khalessi, MD

1 Cerebral Arteriovenous Malformation 1

Jason W. Signorelli • J. Scott Pannell, MD •
Alexander A. Khalessi, MD

2 Cavernous Malformation 9
Jeffrey A. Steinberg, MD • J. Scott Pannell, MD •
Alexander A. Khalessi, MD

3 Ruptured Middle Cerebral Artery Aneurysm 15

Vincent J. Cheung, MD • Jayson A. Sack, MD •
J. Scott Pannell, MD • Alexander A. Khalessi, MD

4 Unruptured Anterior Communicating Artery Aneurysm 21

Vincent J. Cheung, MD • Jayson A. Sack, MD •
J. Scott Pannell, MD • Alexander A. Khalessi, MD

5 Intradural Internal Carotid Artery Fusiform Aneurysm 25

Gunjan Goel, MD • J. Scott Pannell, MD •
Alexander A. Khalessi, MD

6 Spinal Arteriovenous Malformations 31

J. Scott Pannell, MD • Alexander A. Khalessi, MD

7 Cranial Dural Arteriovenous Fistula 37

Reid Hoside, MD • J. Scott Pannell, MD •
Alexander A. Khalessi, MD

8 Spinal Dural Arteriovenous Fistulas 43

David R. Santiago-Dieppa, MD • J. Scott Pannell, MD •
Scott E. Olson, MD • Alexander A. Khalessi, MD

9 Vertebral Artery Dissection 47

Robert C. Rennert, MD • Jayson A. Sack, MD •
J. Scott Pannell, MD • Alexander A. Khalessi, MD

10 Basilar Tip Aneurysm 53

Robert C. Rennert, MD • Jayson A. Sack, MD •
J. Scott Pannell, MD • Alexander A. Khalessi, MD

11 Endovascular Treatment of Unruptured Aneurysms 61

J. Scott Pannell, MD • Alexander A. Khalessi, MD

v
vi Contents

12 Dominant Hemisphere Hemorrhagic Stroke 69

J. Scott Pannell, MD • Robert C. Rennert, MD •
Scott E. Olson, MD • Alexander A. Khalessi, MD

13 Hypertensive Thalamic Hemorrhage 73

Jason W. Signorelli • J. Scott Pannell, MD •
Alexander A. Khalessi, MD

14 Cerebellar Hemorrhage 81
Reid Hoside, MD • J. Scott Pannell, MD •
Alexander A. Khalessi, MD

15 Moyamoya Disease 85
Brandon C. Gabel, MD • J. Scott Pannell, MD •
Alexander A. Khalessi, MD

16 Venous Sinus Thrombosis 89

Brandon C. Gabel, MD • J. Scott Pannell, MD •
Alexander A. Khalessi, MD

17 Carotid Stenosis 93
Jeffrey A. Steinberg, MD • J. Scott Pannell, MD •
Alexander A. Khalessi, MD

18 Ischemic Stroke Management 101

Joel R. Martin, MD • J. Scott Pannell, MD •
Scott E. Olson, MD • Alexander A. Khalessi, MD

SECTION II
Nontraumatic Cranial Lesions
Section Editor: Griffith R. Harsh IV, MD • J. Dawn Waters, MD

19 Vestibular Schwannoma 109

Robert M. Lober, MD, PhD • Abdulrazag Ajlan, MD

20 Sphenoid Wing Meningioma 115

Omar Choudhri, MD

21 Cerebellar Cystic Hemangioblastoma 121

J. Dawn Waters, MD • Griffith R. Harsh IV, MD

22 Pituitary Apoplexy 127

James Wright, MD • Christina Huang Wright, MD

23 Cushing’s Microadenoma 131

J. Dawn Waters, MD

24 Pituitary Macroadenoma – Prolactinoma 137

Melanie G. Hayden Gephart, MD • YouRong Sophie Su

25 Craniopharyngioma 141
Matthew G. MacDougall, MD • David D. Gonda, MD •
Michael L. Levy, MD, PhD

26 Glioblastoma 147
Kevin K.H. Chow, MD, PhD

27 Anaplastic Oligodendroglioma 151

Christine K. Lee, MD, PhD •
Melanie G. Hayden Gephart, MD

28 Low-Grade Glioma 155

Christina Huang Wright, MD • James Wright, MD
  Contents vii

29 Radiation Necrosis versus Tumor Recurrence 159

Derek Yecies, MD • J. Dawn Waters, MD

30 CNS Lymphoma 163

Zachary Medress • Kai Miller, MD • Li Gordon, MD

31 Brain Metastases 167

Kevin K.H. Chow, MD, PhD

32 Intraventricular Colloid Cyst 171

Arjun V. Pendharkar, MD • Melanie G. Hayden Gephart, MD

33 Cerebral Abscess 175

Aatman Shah • Henry Jung, MD

34 Chiari I Malformation 179

Henry Jung, MD • Aatman Shah

35 Ependymoma 183
Zachary Medress • Melanie G. Hayden Gephart, MD

36 Normal Pressure Hydrocephalus 187

Robert C. Rennert, MD • Vincent J. Cheung, MD •
J. Dawn Waters, MD

37 Arachnoid Cyst 191

J. Dawn Waters, MD

SECTION III
Neurosurgical Trauma
Section Editor: Joseph D. Ciacci, MD

38 Penetrating Head Injuries 195

Vincent J. Cheung, MD • Brandon C. Gabel, MD •
Joseph D. Ciacci, MD

39 Intractable Intracranial Hypertension 201

Vincent J. Cheung, MD • David R. Santiago-Dieppa, MD •
Brandon C. Gabel, MD • Joseph D. Ciacci, MD

40 Epidural Hematoma 205

Vincent J. Cheung, MD • Brandon C. Gabel, MD •
Joseph D. Ciacci, MD

41 Chronic Subdural Hematoma 209

Erik I. Curtis, MD • Brandon C. Gabel, MD •
Joseph D. Ciacci, MD

42 Subaxial Cervical Fracture 213

Erik I. Curtis, MD • Brandon C. Gabel, MD •
Nicholas Fain • Joseph D. Ciacci, MD

43 Odontoid Fractures 219

Brandon C. Gabel, MD • Erik I. Curtis, MD •
Joseph D. Ciacci, MD

44 Hangman’s Fracture 225

Brandon C. Gabel, MD • Vincent J. Cheung, MD •
Joseph D. Ciacci, MD

45 Thoracolumbar Burst Fractures 231

Brandon C. Gabel, MD • Erik I. Curtis, MD •
Joseph D. Ciacci, MD
viii Contents

46 Chance Fractures 237

Brandon C. Gabel, MD • Joseph D. Ciacci, MD

47 Jumped Cervical Facets 241

Brandon C. Gabel, MD • Joseph D. Ciacci, MD

SECTION IV
Spinal Neurosurgery
Section Editor: Adam S. Kanter, MD

48 Atlanto-Axial Dislocation 247

Gurpreet S. Gandhoke, MD • Adam S. Kanter, MD

49 Basilar Invagination - Rheumatoid Pannus 253

Zachary J. Tempel, MD • Robert A. Miller, MD •
Adam S. Kanter, MD

50 Cervical Spondylotic Myelopathy 261

Christian B. Ricks, MD • Nathan T. Zwagerman, MD •
Adam S. Kanter, MD

51 Cauda Equina Syndrome 265

Gurpreet S. Gandhoke, MD • Adam S. Kanter, MD

52 Foot Drop and Far Lateral Disc Herniation 269

Christian B. Ricks, MD • Adam S. Kanter, MD

53 Thoracic Disc Herniation 273

Zachary J. Tempel, MD • Adam S. Kanter, MD

54 Spinal Epidural Abscess 279

Christian B. Ricks, MD • Adam S. Kanter, MD

55 Spinal Metastases 283

Todd Harshbarger, MD • Mike Y. Chen, MD, PhD

56 Spinal Intradural Extramedullary Mass 289

Hazem Mashaly, MD • Zachary J. Tempel, MD •
Adam S. Kanter, MD

57 Intradural Intramedullary Mass 293

Hazem Mashaly, MD • Zachary J. Tempel, MD • Adam S. Kanter MD

58 Cervical Ossified Posterior Longitudinal Ligament 299

Hazem Mashaly, MD • Adam S. Kanter, MD

59 Ankylosing Spondylitis 307

Michael M. McDowell, MD • Zachary J. Tempel, MD •
Adam S. Kanter

60 Chordoma 313
Michael M. McDowell, MD • Zachary J. Tempel, MD •
Adam S. Kanter, MD

SECTION V
Pediatric Neurosurgery
Section Editor: Michael L. Levy, MD, PhD

61 Pineal Tumor 319

Bond Nguyen • Melanie G. Hayden Gephart, MD •
Alexa Smith, MD • Michael L. Levy, MD, PhD
  Contents ix

62 Myelomeningocele 327
Alexa Smith, MD • Bond Nguyen •
Michael L. Levy, MD, PhD

63 Cerebellar Medulloblastoma 331

Michael L. Levy, MD, PhD • John R. Crawford, MD, PhD •
Alexa Smith, MD

64 Brainstem Glioma 337

Michael L. Levy, MD, PhD • John R. Crawford, MD, PhD •
Alexa Smith, MD • Salman Abbasifard, MD

65 Hypothalamic Hamartoma 341

Michael L. Levy, MD, PhD • John R. Crawford, MD, PhD •
Alexa Smith, MD • Salman Abbasifard, MD

66 Endoscopic Third Ventriculostomy 345

Michael L. Levy, MD, PhD • John R. Crawford, MD, PhD •
Alexa Smith, MD • Salman Abbasifard, MD •
Ali H. A. Muhammad Altameemi, MD

67 Slit Ventricle Syndrome 353

Michael L. Levy, MD, PhD • John R. Crawford, MD, PhD •
David S. Hong, MD • Alexa Smith, MD

68 Neural Tube Defect-Tethered Cord Syndrome 357

Hal S. Meltzer, MD • Michael L. Levy, MD, PhD •
Alexa Smith, MD • Salman Abbasifard, MD

69 Craniosynostosis – Plagiocephaly 361

Hal S. Meltzer, MD • Michael L. Levy, MD, PhD •
Alexa Smith, MD • Dillon Levy • Salman Abbasifard, MD

70 Vein of Galen Malformations 367

Brandon C. Gabel MD • Jeffrey A. Steinberg, MD •
Michael L. Levy, MD, PhD

71 Pilocytic Astrocytoma 371

Michael L. Levy, MD, PhD • John R. Crawford, MD, PhD •
Alexa Smith, MD • Ali H. A. Muhammad Altameemi, MD

SECTION VI
Stereotactic and Functional Neurosurgery
Section Editor: Paul S. Larson, MD

72 Trigeminal Neuralgia 377

Andrew L. Ko, MD • Kim J. Burchiel, MD

73 Hemifacial Spasm 381

Thomas J. Gianaris, MD • Aaron Cohen-Gadol, MD •
Nicholas Barbaro, MD

74 Parkinson’s Disease 385

Doris D. Wang, MD, PhD • Philip A. Starr, MD, PhD

75 Progressive Spastic Paraparesis and Decreased Mobility in a Young

Patient 391
Tsinsue Chen, MD • Andrew Shetter, MD • Peter Nakaji, MD

76 Mesial Temporal Sclerosis 397

Nathan C. Rowland, MD, PhD • Edward F. Chang, MD
x Contents

77 Corpus Callosotomy 403

Thomas L. Beaumont, MD, PhD • Matthew D. Smyth, MD

78 Normal Pressure Hydrocephalus 411

Michael Bohl, MD • David S. Xu, MD • Peter Nakaji, MD

79 Idiopathic Intracranial Hypertension (Pseudotumor Cerebri) 415

Benjamin D. Elder, MD, PhD • C. Rory Goodwin, MD, PhD •
Thomas A. Kosztowski, MD • Daniele Rigamonti, MD

80 Intractable Oncologic Pain 423

Nelson Moussazadeh, MD • Michael G. Kaplitt, MD, PhD

81 Spinal Cord Stimulation 429

Daniel M. Birk, MD • Konstantin V. Slavin, MD

SECTION VII
Peripheral Nerve Neurosurgery
Section Editor: Justin Brown, MD

82 Thoracic Outlet Syndrome 435

Justin Brown, MD • Mark A. Mahan, MD

83 Peroneal Neuropathy 439

Mark A. Mahan, MD • Justin Brown, MD

84 Nerve Sheath Tumor 443

Justin Brown, MD • Mark A. Mahan, MD

85 Cubital Tunnel Syndrome 447

Justin Brown, MD • Mark A. Mahan, MD

86 Carpal Tunnel Syndrome 453

Justin Brown, MD • Mark A. Mahan, MD

87 Brachial Plexus Injury 459

Justin Brown, MD • Mark A. Mahan, MD

88 Parsonage-Turner Syndrome 467

Justin Brown, MD • Mark A. Mahan, MD

89 Radial Nerve Injury 471

Justin Brown, MD • Geehan D’Souza, MD •
Mark A. Mahan, MD

90 Ulnar Nerve Injury 477

Justin Brown, MD • Mark A. Mahan, MD

91 Median Nerve Injury 481

Mark A. Mahan, MD • Justin Brown, MD

SECTION VIII
Neurology
Section Editors: Neal Prakash, MD, PhD • Ramsis Benjamin, MD

92 Multiple Sclerosis 489

Audrey Kohar, DO • Neal Prakash, MD, PhD

93 Amyotrophic Lateral Sclerosis 495

Ramsis Benjamin, MD
  Contents xi

94 Guillain-Barré Syndrome 501

Ramsis Benjamin, MD

95 Devic’s Syndrome 507

Audrey Kohar, DO • Noriko Salamon, MD •
Neal Prakash, MD, PhD

96 Human Immunodeficiency Virus 511

Ramsis Benjamin, MD

97 Status Epilepticus 517

Neal Prakash, MD, PhD

98 Neurosarcoidosis 521
Ramsis Benjamin, MD

99 Transverse Myelitis 525

Audrey Kohar, DO • Neal Prakash, MD, PhD

100 Giant Cell Arteritis 529

Ramsis Benjamin, MD

Glossary 533
APPENDICES
Section Editors: Henry E. Aryan, MD • Aasim S. Kazmi, MD

Appendix A Neuropathology 541

Appendix B Neurology 549
Appendix C Neuroradiology 557
Appendix D Spinal Fracture Grading 563
Appendix E Peripheral Nerve Exam 571
Appendix F Neurocutaneous Disorders 573
Appendix G Positioning 575

Index 579
 Preface

As the most challenging discipline, Neurosurgery rebuffs any single text’s attempt at reveal-
ing its intricacies and complexities. Accordingly, this text and its individual chapters aim
for a more humble goal. Together, they aspire to serve as a primer of essential material
often reviewed during certification examinations and a framework into which deeper
knowledge can be contextualized.
From the perspective of didactic utility, the standard, time-tested neurosurgical text-
books offer a distillation of the most useful art and schemata. Therefore, figures from these
familiar texts have been incorporated into this book, along with new art and imaging, in
the hope that the aggregate will constitute a robust visual fabric within 100 Case Reviews
in Neurosurgery.
The book is divided into intuitive sections. The information provided and the questions
posed follow the experience of a neurosurgeon being consulted in the hospital or seeing
a new patient in clinic that has come to them for care. The vascular section covers surgical
and nonsurgical elements that are key elements of essential vascular cases. The peripheral
nerve section is particularly detailed since this is a specialized field most general neuro-
surgeons have limited exposure to in daily practice. The appendices provide information
that is vital yet cumbersome to include in the flow of the chapters. The layout and pre-
sentation of information follows the formats of common grand rounds and examinations
most readers have experienced from the beginning of their neurosurgical training through
their current continuing education.
The most challenging part of constructing the book you now read has been to find that
elusive balance invaluable to the modern pedagogical text between comprehensiveness
and concision, between textual explanation and visual illustration, between esoteric speci-
ficity and simple intelligibility. My hope is that the content presented here has been
insightfully and incisively curated for your purposes.

Rahul Jandial

xii
 List of Contributors
Salman Abbasifard, MD
International Pediatric Neurosurgery
Fellow
Rady Children’s Hospital
University of California – San Diego
San Diego, CA, USA
Case 64: Brainstem Glioma
Case 65: Hypothalamic Hamartoma
Case 66: Endoscopic Third
Ventriculostomy
Case 68: Neural Tube Defect–Tethered
Cord Syndrome
Case 69: Craniosynostosis
– Plagiocephaly
Michele R. Aizenberg, MD
Associate Professor of Neurological
Surgery and Oncology
Director, Brain and Spine Cancer Center
University of Nebraska Medical Center
Omaha, NE, USA
Abdulrazag Ajlan, MD
Clinical Instructor
Department of Neurosurgery
Stanford Hospitals and Clinics
Stanford, CA, USA
Case 19: Vestibular Schwannoma
Ali H. A. Muhammad Altameemi, MD
International Fellow of Neurosurgery
Rady Children’s Hospital San Diego
Division of Pediatric Neurosurgery
University of California – San Diego
San Diego, CA, USA
Case 66: Endoscopic Third
Ventriculostomy
Case 71: Pilocytic Astrocytoma
Henry E. Aryan, MD
Clinical Professor of Neurosurgery, UC
San Francisco
Chief, Spine Center
Sierra Pacific Orthopedic & Spine Center
Fresno, CA, USA
Section Editor for Appendices
Nicholas Barbaro, MD
Chairman
Department of Neurosurgery
Indiana University School of Medicine
Indianapolis, IN, USA
Case 73: Hemifacial Spasm
Thomas L. Beaumont, MD, PhD
Senior Resident
Department of Neurological Surgery
Washington University School of
Medicine
St. Louis, MO, USA
Case 77: Corpus Callosotomy
Ramsis Benjamin, MD
City of Hope National Medical Center
Duarte, CA, USA
Section Editor for Section 8
Neurology
Case 93: Amyotrophic Lateral
Sclerosis
Case 94: Guillain-Barré Syndrome
Case 96: Human Immunodeficiency
Virus
Case 98: Neurosarcoidosis
Case 100: Giant Cell Arteritis
Daniel M. Birk, MD
Resident
Department of Neurosurgery
University of Illinois at Chicago
Chicago, IL, USA
Case 81: Spinal Cord Stimulation
Michael Bohl, MD
Resident Physician
Division of Neurological Surgery
Barrow Neurological Institute
St. Joseph’s Hospital and Medical Center
Phoenix, AZ, USA
Case 78: Normal Pressure
Hydrocephalus
xiii
xiv List of Contributors
Justin Brown, MD
Associate Professor
Department of Neurosurgery
University of California
San Diego School of Medicine
San Diego, CA, USA
Section Editor for Section 7
Peripheral Nerve Neurosurgery
Case 82: Thoracic Outlet Syndrome
Case 83: Peroneal Neuropathy
Case 84: Nerve Sheath Tumor
Case 85: Cubital Tunnel Syndrome
Case 86: Carpal Tunnel Syndrome
Case 87: Brachial Plexus Injury
Case 88: Parsonage-Turner Syndrome
Case 89: Radial Nerve Injury
Case 90: Ulnar Nerve Injury
Case 91: Median Nerve Injury
Kim J. Burchiel, MD
John Raaf Professor and Chairman
Department of Neurological Surgery
Oregon Health and Science University
Portland, OR, USA
Case 72: Trigeminal Neuralgia
Edward F. Chang, MD
Associate Professor
Department of Neurological Surgery
University of California – San Francisco
San Francisco, CA, USA
Case 76: Mesial Temporal Sclerosis
Mike Y. Chen, MD, PhD
Associate Professor
Division of Neurosurgery, Department of
Surgery
City of Hope Cancer Center & Beckman
Research Institure
Los Angeles, CA, USA
Case 55: Spinal Metastases
Tsinsue Chen, MD
Neurosurgery Resident
Division of Neurological Surgery
Barrow Neurological Institute
St. Joseph’s Hospital and Medical Center
Phoenix, AZ, USA
Case 75: Progressive Spastic
Paraparesis and Decreased Mobility in
a Young Patient
Vincent J. Cheung, MD
Neurosurgical Resident
Division of Neurosurgery
University of California – San Diego
San Diego, CA, USA
Case 3: Ruptured Middle Cerebral
Artery Aneurysm
Case 4: Unruptured Anterior
Communicating Artery Aneurysm
Case 36: Normal Pressure
Hydrocephalus
Case 38: Penetrating Head Injury
Case 39: Intractable Intracranial
Hypertension
Case 40: Epidural Hematoma
Case 44: Hangman’s Fracture
Omar Choudhri, MD
Neurosurgery Chief Resident
Stanford University School of Medicine
Stanford, CA, USA
Case 20: Sphenoid Wing Meningioma
Kevin K.H. Chow, MD, PhD
Neurosurgery Resident
Department of Neurosurgery
Stanford University School of Medicine
Palo Alto, CA, USA
Case 26: Glioblastoma
Case 31: Brain Metastases
Joseph D. Ciacci, MD
Program Director UCSD Neurosurgery
Residency
Academic Community Director
UCSD School of Medicine
Chief of Neurosurgery VASDHS
Professor, Division of Neurosurgery
University of California, San Diego
School of Medicine
San Diego, CA, USA
Section Editor for Section 3
Neurosurgical Trauma
Case 38: Penetrating Head Injury
Case 39: Intractable Intracranial
Pressure
Case 40: Epidural Hematoma
Case 41: Chronic Subdural Hematoma
Case 42: Subaxial Cervical Fracture
Case 43: Odontoid Fractures
Case 44: Hangman’s Fracture
Case 45: Thoracolumbar Burst
Fractures
Case 46: Chance Fractures
Case 47: Jumped Cervical Facets

Aaron Cohen-Gadol, MD
Associate Professor
Department of Neurosurgery
Indiana University School of Medicine
Indianapolis, IN, USA
Case 73: Hemifacial Spasm
John R. Crawford, MD, PhD
Associate Professor of Clinical
Neurosciences and Pediatrics
University of California – San Diego
Director Neuro-Oncology Rady Children’s
Hospital
San Diego, CA, USA
Case 63: Cerebellar Medulloblastoma
Case 64: Brainstem Glioma
Case 65: Hypothalamic Hamartoma
Case 66: Endoscopic Third
Ventriculostomy
Case 67: Slit Ventricle Syndrome
Case 71: Pilocytic Astrocytoma
Erik I. Curtis, MD
Neurosurgical Resident
Division of Neurosurgery
University of California, San Diego
School of Medicine
San Diego, CA, USA
Case 41: Chronic Subdural Hematoma
Case 42: Subaxial Cervical Fracture
Case 43: Odontoid Fractures
Case 45: Thoracolumbar Burst
Fractures
Gehaan D’Souza, MD
Fellow in Plastic Surgery
Department of Plastic Surgery
University of California
San Diego School of Medicine
San Diego, CA, USA
Case 89: Radial Nerve Injury
Benjamin D. Elder, MD, PhD
Resident
Department of Neurosurgery
The Johns Hopkins University School of
Medicine
Baltimore, MD, USA
Case 79: Idiopathic Intracranial
Hypertension (Pseudotumor Cerebri)
Nicholas Fain, MD
Resident Physician
Department of Radiology
University of Iowa
Iowa City, IA, USA
Case 42: Subaxial Cervical Fracture
 List of Contributors xv
Brandon C. Gabel, MD
Neurosurgical Resident
Division of Neurosurgery
University of California, San Diego
School of Medicine
San Diego, CA, USA
Case 15: Moyamoya Disease
Case 16: Venous Sinus Thrombosis
Case 38: Penetrating Head Injury
Case 39: Intractable Intracranial
Hypertension
Case 40: Epidural Hematoma
Case 41: Chronic Subdural Hematoma
Case 42: Subaxial Cervical Fracture
Case 43: Odontoid Fractures
Case 44: Hangman’s Fracture
Case 45: Thoracolumbar Burst
Fractures
Case 46: Chance Fractures
Case 47: Jumped Cervical Facets
Case 70: Vein of Galen Malformations
Gurpreet S. Gandhoke, MD
Department of Neurological Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Case 48: Atlanto-Axial Dislocation
Case 51: Cauda Equina Syndrome
Melanie G. Hayden Gephart, MD
Assistant Professor
Department of Neurosurgery
Stanford University School of Medicine
Stanford, CA, USA
Case 24: Pituitary Macroadenoma
– Prolactinoma
Case 27: Anaplastic
Oligodendroglioma
Case 32: Intraventricular Colloid Cyst
Case 35: Ependymoma
Case 61: Pineal Tumor
Thomas J. Gianaris, MD
Resident
Department of Neurosurgery
Indiana University School of Medicine
Indianapolis, IN, USA
Case 73: Hemifacial Spasm
Gunjan Goel, MD
Neurosurgical Resident
Division of Neurosurgery
University of California – San Diego
San Diego, CA, USA
Case 5: Intradural Internal Carotid
Artery Fusiform Aneurysm
xvi List of Contributors
David D. Gonda, MD
Neurosurgery Chief Resident
Division of Neurosurgery
University of California – San Diego
San Diego, CA, USA
Case 25: Craniopharyngioma
C. Rory Goodwin, MD, PhD
Resident
Department of Neurosurgery
The Johns Hopkins University School of
Medicine
Baltimore, MD, USA
Case 79: Idiopathic Intracranial
Hypertension (Pseudotumor Cerebri)
Li Gordon, MD
Assistant Professor, Department of
Neurosurgery
Stanford University School of Medicine
Stanford, CA, USA
Case 30: CNS Lymphoma
Griffith R. Harsh IV, MD
Professor
Department of Neurosurgery
Stanford Hospital and Clinics
Stanford, CA, USA
Section Editor for Section 2 Non-
traumatic Cranial Lesions
Case 21: Cerebellar Cystic
Hemangioblastoma
Todd Harshbarger, MD
Neurosurgery Division, City of Hope
Duarte, CA, USA
Case 55: Spinal Metastases
David S. Hong, MD
Pediatric Neurosurgery Fellow
Division of Pediatric Neurosurgery
Rady Children’s Hospital San Diego
University of California – San Diego
San Diego, CA, USA
Case 67: Slit Ventricle Syndrome
Reid Hoside, MD
Neurosurgical Resident
Division of Neurosurgery
University of California – San Diego
San Diego, CA, USA
Case 7: Cranial Dural Arteriovenous
Fistula
Case 14: Cerebellar Hemorrhage
Rahul Jandial, MD, PhD
Associate Professor
Division of Neurosurgery, Department of
Surgery
City of Hope Cancer Center & Beckman
Research Institure
Los Angeles, CA, USA
Henry Jung, MD
Neurosurgery Resident
Department of Neurosurgery
Stanford Hospital and Clinics
Stanford, CA, USA
Case 33: Cerebral Abscess
Case 34: Chiari I Malformation
Adam S. Kanter, MD
Associate Professor
Department of Neurological Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Section Editor for Section 4 Spinal
Neurosurgery
Case 48: Atlanto-Axial Dislocation
Case 49: Basilar Invagination –
Rheumatoid Pannus
Case 50: Cervical Spondylotic
Myelopathy
Case 51: Cauda Equina Syndrome
Case 52: Foot Drop and Far Lateral
Disc Herniation
Case 53: Thoracic Disc Herniation
Case 54: Spinal Epidural Abscess
Case 56: Spinal Intradural
Extramedullary Mass
Case 57: Intradural Intramedullary
Mass
Case 58: Cervical Ossified Posterior
Longitudinal Ligament
Case 59: Ankylosing Spondylitis
Case 60: Chordoma
Michael G. Kaplitt, MD, PhD
Residency Director and Vice Chairman
for Research
Department of Neurological Surgery
Weill Cornell Medical College
New York Presbyterian Hospital
New York, NY, USA
Case 80: Intractable Oncologic Pain
Aasim S. Kazmi, MD
Section of Neurosurgery
Meridian Health
Wall, NJ, USA
Section Editor for Appendices

Alexander A. Khalessi, MD
Director of Endovascular Neurosurgery
Surgical Director of Neurocritical Care
Assistant Professor of Surgery and
Neurosciences
University of California – San Diego
San Diego, CA, USA
Section Editor for Section 1 Vascular
Neurosurgery
Case 1: Cerebral Arteriovenous
Malformation
Case 2: Cavernous Malformation
Case 3: Ruptured Middle Cerebral
Artery Aneurysm
Case 4: Unruptured Anterior
Communicating Artery Aneurysm
Case 5: Intradural Internal Carotid
Artery Fusiform Aneurysm
Case 6: Spinal Arteriovenous
Malformations
Case 7: Cranial Dural Arteriovenous
Fistula
Case 8: Spinal Dural Arteriovenous
Fistulas
Case 9: Vertebral Artery Dissection
Case 10: Basilar Tip Aneurysm
Case 11: Endovascular Treatment of
Unruptured Aneurysms
Case 12: Dominant Hemisphere
Hemorrhagic Stroke
Case 13: Hypertensive Thalamic
Hemorrhage
Case 14: Cerebellar Hemorrhage
Case 15: Moyamoya Disease
Case 16: Venous Sinus Thrombosis
Case 17: Carotid Stenosis
Case 18: Ischemic Stroke
Management
Andrew L. Ko, MD
Fellow, Stereotactic and Functional
Neurosurgery
Department of Neurological Surgery
Oregon Health and Science University
Portland, OR, USA
Case 72: Trigeminal Neuralgia
Audrey Kohar, DO
Physical Medicine and Rehabilitation
University of California
Irvine, CA, USA
Case 92: Multiple Sclerosis
Case 95: Devic’s Syndrome
Case 99: Transverse Myelitis
 List of Contributors xvii
Thomas A. Kosztowski, MD
Resident
Department of Neurosurgery
The Johns Hopkins University School of
Medicine
Baltimore, MD, USA
Case 79: Idiopathic Intracranial
Hypertension (Pseudotumor Cerebri)
Christine K. Lee, MD, PhD
MD/PhD Student
Stanford University School of Medicine
Stanford, CA, USA
Case 27: Anaplastic
Oligodendroglioma
Paul S. Larson, MD
Professor and Vice Chair
Department of Neurological Surgery
University of California – San Francisco
San Francisco, CA, USA
Section Editor for Section 6
Stereotactic and Functional
Neurosurgery
Dillon Levy
Pre-Medical Student
University of San Diego
San Diego, CA. USA
Case 69: Craniosynostosis
– Plagiocephaly
Michael L. Levy, MD, PhD
Professor and Chief
Division of Pediatric Neurosurgery
Rady Children’s Hospital – San Diego
San Diego, CA, USA
Section Editor for Section 5 Pediatric
Neurosurgery
Case 25: Craniopharyngioma
Case 61: Pineal Tumor
Case 62: Myelomeningocele
Case 63: Cerebellar Medulloblastoma
Case 64: Brainstem Glioma
Case 65: Hypothalamic Hamartoma
Case 66: Endoscopic Third
Ventriculostomy
Case 67: Slit Ventricle Syndrome
Case 68: Neural Tube Defect–Tethered
Cord Syndrome
Case 69: Craniosynostosis
– Plagiocephaly
Case 70: Vein of Galen Malformations
Case 71: Pilocytic Astrocytoma
xviii List of Contributors
Robert M. Lober, MD, PhD
Chief Resident
Department of Neurosurgery
Stanford Hospitals and Clinics
Stanford, CA, USA
Case 19: Vestibular Schwannoma
Matthew G. MacDougall, MD
Neurosurgery Resident
Division of Neurosurgery
University of California – San Diego
San Diego, CA, USA
Case 25: Craniopharyngioma
Mark A. Mahan, MD
Assistant Professor
Department of Neurosurgery
Clinical Neurosciences Center
University of Utah
Salt Lake City, UT, USA
Case 82: Thoracic Outlet Syndrome
Case 83: Peroneal Neuropathy
Case 84: Nerve Sheath Tumor
Case 85: Cubital Tunnel Syndrome
Case 86: Carpal Tunnel Syndrome
Case 87: Brachial Plexus Injury
Case 88: Parsonage-Turner Syndrome
Case 89: Radial Nerve Injury
Case 90: Ulnar Nerve Injury
Case 91: Median Nerve Injury
Joel R. Martin, MD
Neurosurgical Resident
Division of Neurosurgery
University of California-San Diego
San Diego, CA, USA
Case 18: Ischemic Stroke
Management
Hazem Mashaly, MD
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Case 56: Spinal Intradural
Extramedullary Mass
Case 57: Spinal Intramedullary Mass
Case 58: Cervical Ossified Posterior
Longitudinal Ligament
Michael M. McDowell, MD
Department of Neurological Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Case 59: Ankylosing Spondylitis
Case 60: Chordoma
Zachary Medress
Medical Student
Stanford University School of Medicine
Stanford, CA, USA
Case 30: CNS Lymphoma
Case 35: Ependymoma
Hal S. Meltzer, MD
Neurosurgical Director of Craniofacial
Program
Rady Children’s Hospital San Diego
Professor of Neurosurgery
University of California, San Diego
San Diego, CA, USA
Case 68: Neural Tube Defect–Tethered
Cord Syndrome
Case 69: Craniosynostosis
– Plagiocephaly
Kai Miller, MD
Resident, Department of Neurosurgery
Stanford University School of Medicine
Stanford, CA, USA
Case 30: CNS Lymphoma
Robert A. Miller, MD
Department of Neurological Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Case 49: Basilar Invagination –
Rheumatoid Pannus
Nelson Moussazadeh, MD
Resident in Neurological Surgery
Weill Cornell Medical College
New York Presbyterian Hospital
New York, NY, USA
Case 80: Intractable Oncologic Pain
Peter Nakaji, MD
Residency Program Director
Division of Neurological Surgery
Barrow Neurological Institute
St. Joseph’s Hospital and Medical Center
Phoenix, AZ, USA
Case 75: Progressive Spastic
Paraparesis and Decreased Mobility in
a Young Patient
Case 78: Normal Pressure
Hydrocephalus
Bond Nguyen
University of California – Irvine
Irvine, CA, USA
Case 61: Pineal Tumor
Case 62: Myelomeningocele

Scott E. Olson, MD
Assistant Professor of Surgery and
Neurosciences
Division of Neurosurgery
University of California – San Diego
San Diego, CA, USA
Case 8: Spinal Dural Arteriovenous
Fistulas
Case 12: Dominant Hemisphere
Hemorrhagic Stroke
Case 18: Ischemic Stroke
Management
J. Scott Pannell, MD
Endovascular Neurosurgery Fellow
Division of Neurosurgery
University of California – San Diego
San Diego, CA, USA
Case 1: Cerebral Arteriovenous
Malformation
Case 2: Cavernous Malformation
Case 3: Ruptured Middle Cerebral
Artery Aneurysm
Case 4: Unruptured Anterior
Communicating Artery Aneurysm
Case 5: Intradural Internal Carotid
Artery Fusiform Aneurysm
Case 6: Spinal Arteriovenous
Malformations
Case 7: Cranial Dural Arteriovenous
Fistula
Case 8: Spinal Dural Arteriovenous
Fistulas
Case 9: Vertebral Artery Dissection
Case 10: Basilar Tip Aneurysm
Case 11: Endovascular Treatment of
Unruptured Aneurysms
Case 12: Dominant Hemisphere
Hemorrhagic Stroke
Case 13: Hypertensive Thalamic
Hemorrhage
Case 14: Cerebellar Hemorrhage
Case 15: Moyamoya Disease
Case 16: Venous Sinus Thrombosis
Case 17: Carotid Stenosis
Case 18: Ischemic Stroke
Management
Arjun V. Pendharkar, MD
Department of Neurosurgery
Stanford University School of Medicine
Palo Alto, CA, USA
Case 32: Intraventricular Colloid Cyst
 List of Contributors xix
Neal Prakash, MD, PhD
City of Hope National Medical Center
Chief of Neurology
Associate Clinical Professor of Neurology
Director of Neurological Optical Imaging
Duarte, CA, USA
Section Editor for Section 8
Neurology
Case 92: Multiple Sclerosis
Case 95: Devic’s Syndrome
Case 97: Status Epilepticus
Case 99: Transverse Myelitis
Robert C. Rennert, MD
Neurosurgical Resident
Division of Neurosurgery
University of California – San Diego
San Diego, CA, USA
Case 9: Vertebral Artery Dissection
Case 10: Basilar Tip Aneurysm
Case 12: Dominant Hemisphere
Hemorrhagic Stroke
Case 36: Normal Pressure
Hydrocephalus
Christian B. Ricks, MD
Department of Neurological Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Case 50: Cervical Spondylotic
Myelopathy
Case 52: Foot Drop and Far Lateral
Disc Herniation
Case 54: Spinal Epidural Abscess
Daniele Rigamonti, MD
Professor
Department of Neurosurgery
The Johns Hopkins University School of
Medicine
Baltimore, MD
Case 79: Idiopathic Intracranial
Hypertension (Pseudotumor Cerebri)
Nathan C. Rowland, MD, PhD
Chief Resident
Department of Neurological Surgery
University of California – San Francisco
San Francisco, CA, USA
Case 76: Mesial Temporal Sclerosis
xx List of Contributors
Jayson A. Sack, MD
Neurosurgical Resident
Division of Neurosurgery
University of California – San Diego
San Diego, CA, USA
Case 3: Ruptured Middle Cerebral
Artery Aneurysm
Case 4: Unruptured Anterior
Communicating Artery Aneurysm
Case 9: Vertebral Artery Dissection
Case 10: Basilar Tip Aneurysm
Noriko Salamon, MD, PhD
Professor of Radiology
Chief of Neuroradiology
Section of Neuroradiology
Department of Radiological Sciences
David Geffen School of Medicine at
UCLA
Ronald Reagan Medical Center
Los Angeles, CA, USA
Case 95: Devic’s Syndrome
David R. Santiago-Dieppa, MD
Neurosurgical Resident
Division of Neurosurgery
University of California – San Diego
San Diego, CA, USA
Case 8: Spinal Dural Arteriovenous
Fistulas
Case 39: Intractable Intracranial
Hypertension
Aatman Shah, BS
Medical Student
Department of Neurosurgery
Stanford Hospital and Clinics
Stanford, CA, USA
Case 33: Cerebral Abscess
Case 34: Chiari I Malformation
Andrew Shetter, MD
Chair, Section of Functional Stereotactic
Neurosurgery
Division of Neurological Surgery
Barrow Neurological Institute
St. Joseph’s Hospital and Medical Center
Phoenix, AZ, USA
Case 75: Progressive Spastic
Paraparesis and Decreased Mobility in
a Young Patient
Jason W. Signorelli
Medical Student
Division of Neurosurgery
University of California – San Diego
San Diego, CA, USA
Case 1: Cerebral Arteriovenous
Malformation
Case 13: Hypertensive Thalamic
Hemorrhage
Konstantin V. Slavin, MD
Professor
Department of Neurosurgery
University of Illinois at Chicago
Chicago, IL, USA
Case 81: Spinal Cord Stimulation
Alexa Smith, MD
Pediatric Neurosurgery Fellow
Rady Children’s Hospital – San Diego
Division of Pediatric Neurosurgery
University of California, San Diego
San Diego, CA, USA
Case 61: Pineal Tumor
Case 62: Myelomeningocele
Case 63: Cerebellar Medulloblastoma
Case 64: Brainstem Glioma
Case 65: Hypothalamic Hamartoma
Case 66: Endoscopic Third
Ventriculostomy
Case 67: Slit Ventricle Syndrome
Case 68: Neural Tube Defect–Tethered
Cord Syndrome
Case 69: Craniosynostosis
– Plagiocephaly
Case 71: Pilocytic Astrocytoma
Matthew D. Smyth, MD
Associate Professor of Neurosurgery and
Pediatrics
Director, Pediatric Epilepsy Program
Department of Neurological Surgery
Washington University School of
Medicine
St. Louis, MO, USA
Case 77: Corpus Callosotomy
Philip A. Starr, MD, PhD
Professor and Co-Director, Functional
Neurosurgery Program
Department of Neurological Surgery
University of California – San Francisco
San Francisco, CA, USA
Case 74: Parkinson’s Disease

Jeffrey A. Steinberg, MD
Division of Neurosurgery
University of California – San Diego
San Diego, CA, USA
Case 2: Cavernous Malformation
Case 17: Carotid Stenosis
Case 70: Vein of Galen Malformations
YouRong Sophie Su
Medical Student
Stanford University School of Medicine
Stanford, CA, USA
Case 24: Pituitary Macroadenoma
– Prolactinoma
Zachary J. Tempel, MD
Department of Neurological Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Case 49: Basilar Invagination –
Rheumatoid Pannus
Case 53: Thoracic Disc Herniation
Case 56: Spinal Intradural
Extramedullary Mass
Case 57: Intradural Intramedullary
Mass
Case 59: Ankylosing Spondylitis
Case 60: Chordoma
Doris D. Wang, MD, PhD
Resident Physician
Department of Neurological Surgery
University of California – San Francisco
San Francisco, CA, USA
Case 74: Parkinson’s Disease
J. Dawn Waters, MD
Clinical Instructor
Department of Neurosurgery
Stanford Hospital and Clinics
Stanford, CA, USA
Section Editor for Section 2 Non-
traumatic Cranial Lesions
Case 21: Cerebellar Cystic
Hemangioblastoma
Case 23: Cushing’s Microadenoma
Case 29: Radiation Necrosis versus
Tumor Recurrence
Case 36: Normal Pressure
Hydrocephalus
Case 37: Arachnoid Cyst
 List of Contributors xxi
Christina Huang Wright, MD
Resident Physician
Department of Neurological Surgery
University of Southern California School
of Medicine
Los Angeles, CA, USA
Case 22: Pituitary Apoplexy
Case 28: Low-Grade Glioma
James Wright, MD
Resident Physician
Department of Neurological Surgery
Case Western Reserve University School
of Medicine
Cleveland, OH, USA
Case 22: Pituitary Apoplexy
Case 28: Low-Grade Glioma
David S. Xu, MD
Resident Physician
Division of Neurological Surgery
Barrow Neurological Institute
St. Joseph’s Hospital and Medical Center
Phoenix, AZ, USA
Case 78: Normal Pressure
Hydrocephalus
Derek Yecies, MD
Resident
Department of Neurosurgery
Stanford Hospitals and Clinics
Stanford, CA, USA
Case 29: Radiation Necrosis versus
Tumor Recurrence
Nathan T. Zwagerman, MD
Department of Neurological Surgery
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Case 50: Cervical Spondylotic
Myelopathy
 Acknowledgements

For those that have not had the opportunity to assemble a text, the immense collaborative
effort can be lost behind the bold, large font names on the cover. Yes, the editors are key
to the process. Equally important is the publishing team. Alexandra Mortimer, Louisa
Talbott and Andrew Riley have been thoughtful and attentive companions in making this
book. The book would be porous and flawed without them. Most importantly Charlotta
Kryhl has helped shepherd us through the original idea, its need in the neurosurgical
community and ultimately the spirit of this textbook. Thank you for your support and
leadership.

xxii
 For boundless love
For unwavering support
For my mother, Sushma Jandial
Rahul Jandial
This page intentionally left blank
 Chen, Ph.D, for gifting me his disdain of the conventional-and
to my mother, Professor S.J. Chen,
for my brutal endurance and voice of reason.
Mike Y. Chen

I am grateful to all of my colleagues for their collaboration,

expertise, and friendship. I am appreciative of our residents
who motivate us to be even better. Also, my patients,
who inspire me to persevere.

I dedicate this book to family: My mother, Lenore, for her endless

commitment to our happiness. My father, Stephen, who is missed
beyond words. My in-laws, Shari and Ali, for their undying love
and support. My husband, Shervin, for his sacrifices for my
dedication to my profession. My children, Ava and Cyrus,
who have enriched my life in ways I never thought possible,
making me a better person and surgeon.
Michele R. Aizenberg
This page intentionally left blank
 Section I Vascular
Neurosurgery
Case 1
Cerebral Arteriovenous
Malformation
Jason W. Signorelli •Alexander
J. Scott Pannell, MD •
A. Khalessi, MD

Presentation
An 18-year-old female presents to the ED with severe headaches, nausea, vomiting, and
complex partial seizure beginning on the right side of the body. She has no history of prior
seizures. She has had headaches in the past, but this headache is worse than usual.
• PMH: otherwise unremarkable; no recent trauma
• Exam: mild left-sided weakness

Differential Diagnosis
• Vascular
• Ischemic/embolic stroke
• Arteriovenous malformation (AVM)
• Cavernous hemangioma
• Aneurysm rupture
• Moyamoya disease
• Infectious
• CNS infection (herpes simplex encephalitis)
• Neoplastic
• Primary cerebral tumor
• Metastasis (most commonly lung, renal cell carcinoma, melanoma, breast)
• Metabolic/toxic/nutritional
• Alcohol withdrawal
• Drug intoxication
• Electrolyte abnormalities
• Hypoglycemia
• Congenital/developmental
• Osler-Weber-Rendu disease
• Sturge-Weber syndrome
• Wyburn-Mason syndrome (“Bonnet–Dechaume–Blanc syndrome”)

1
Another random document with
no related content on Scribd:
 Assistiu-lhe o piedoso bispo até o ultimo valle, e logo seu corpo foi
levado por homens principaes ao Hospicio de Nossa Senhora da
Penha dos Capuchinhos Francezes, o dia em que chegavam as
novas da restauração do famoso Palmar a Pernambuco, que havia
de ser o sexto da victoria, pois tanto gasta um caminheiro apressado
de um logar a outro. Mas é em vão busca-lo em Pitta, auctor
moderno que d’isto tracta como si não tractára. E mais me
escandalisa que passasse em sua mesma patria por um poeta de tal
nome seu contemporaneo, com quem devia gastar parte d’aquelles
elogios. Morreu finalmente no anno de 1696 com edade de setenta
e tres annos.
Este é o mais abreviado resumo que posso dar da vida do meu
suspirado, quão dilectissimo poeta lyrico; e oxalá podéra eu publicar
os prodigiosos fundamentos do meu amor, derramando entre as
gentes o manancial thesouro de suas graças! Singular foi a estrella
que dominou em seu engenho; porque a toda a circumferencia das
luzes apolineas brilhou com egualdade senhoril; e não menos
prodigioso aquelle não sei que de sua guarda, porque offendendo ás
claras muitas pessoas, de quem o menor movimento seria sem
duvida uma tyranna morte, sempre se atreveu, e nunca de seu motu
proprio cautelou perigos; morrendo intacto de tão prolongados
mezes.
Muitos eram os feridos do seu ferro que consultaram o remedio no
mesmo instrumento da chaga, beijando a Achilles a lança que os
traspassára. Raro testimunho d’esta fatalidade foi a resposta que
deu a um queixoso certo governador severamente resoluto: «Não
faça V. Mᶜᵉ. caso (disse), porque isso tambem passa por mim, sem
que por mim passe a minima tenção de o castigar.»
Testimunho d’esta fatalidade são as duas quartas de um soneto,
que se fez em sua morte; o qual não escrevo por inteiro em razão
de que si os seus principios professam a verdade pura, os fins
todavia contém temeraria petulancia:

Morreste emfim, Gregorio esclarecido,

Que sabendo tirar por varios modos
 A fama, a honra, o credito de todos,
D’esses mesmos te viste applaudido.

Entendo que outro tal não tem nascido

Entre os Romanos, Gregos, Persas, Godos,
Que comtigo mereça ter apodos
Nos applausos, que assim has adquirido.

Muitas vezes quiz elle refrear o genio, que conhecia

prejudialmente peccaminoso, fazendo os actos de christão que em
seu logar veremos, mas debalde o intentava, porque o seu furor
intrepido imperava dominante na massa sanguinaria contra os
desacertos d’aquella edade, castigados por Deus com tão horrorosa
peste e tão repetidas fomes: como tambem veremos pelo decurso
d’estas obras. E não é de admirar que disparadas do throno da
divina justiça aquellas duas lanças de sua via, seguisse a terceira
com tão exquisito genero de guerra em um homem, que de sua mãe
unicamente tomou este appellido entre outros partos: ella o deu
appelidando-se—da Guerra—, e elle o foi sem aquella proposição
da, por ser a mesma guerra, e não o instrumento d’ella. Isto parece
que prophetizou corto inimigo seu, respondendo-lhe a uma satyra
com outra na seguinte fórma:

Porém si em nada és guerreiro,

Para que te chamas guerra,
E a fazes a toda a terra
Com a lingua, que é mor damno, &.

Deixou o dr. Gregorio de Mattos um filho de sua mulher Maria de

Povos, chamado Gonçalo de Mattos, cujo amor publica em várias
obras este livro, que em seus logares se verão sem enfadosas citas.

o quente da cama
Com Gonçalo, e com sua ama,
 Dizendo estava comei-me, &.
Por vida do meu Gonçalo,
Custodia formosa e linda, &.
Madrasta do Gonçalinho,
Que é lindo enteado a fé, &.
Sim, por vida de Gonçalo, &.
Mas por vida de Gonçalo, &.

D’este moço, que com sua mãe ficou em summa pobreza e

desamparo, correm noticias muito geraes que totalmente
degenerára d’aquella massa scientifica de seus estupendos
progenitores. Bem pudera eu duvida-lo em uma terra, onde sempre
se hão de tomar os echos da fama pelo contrario; pois nunca vi nella
abonar um sujeito que não mereça ser desterrado por máu, nem
vituperar outro que ao contrario desmereça elogios de bom.
Mas para cumprir com os relativos d’esta historia consultei dous
sujeitos que se criaram com Gonçalo de Mattos, ambos de instincto
capaz para uma informação, e entre elles achei a contradicção, que
póde servir de exemplo a quem se informa: um affirma com
juramento que era poeta natural, o outro jurando nega que tal fosse,
dizendo que elle nem o Padre Nosso era capaz de repetir. A este
seguem muitos, e nenhum áquelle: mas o primeiro chamado
Christovão Rodrigues diz que em sua adolescencia lhe dera o
seguinte mote:

Com que, porque, para que.

Defendia-se o Gonçalo temeroso de uma maldição condicional de

sua mãe, em respeito da qual não queria pegar na penna para fazer
versos, posto que no animo lhe pulsavam as Musas (tal foi o
escarmento que deixaram ellas naquelles cadaveres da paciencia
lastimosa). Mas como a condição do preceito tinha sua clausula, em
que fundar-se uma heresia graciosa, respondeu importunado:
«Pegae vós na penna, porque a maldição de minha mãe parece que
não me prohibe fazer versos, mas sim pegar na penna para elles.»
Repetiu-me então esta decima, que tanto ella como a resposta, si
são verdadeiras, vem a ser uns relampagos da esphera do fogo:

GLOSA.

Disse Clori que me amava

Para o intento que tem,
O qual não disse a ninguem,
Nem o porque declarava:
Eu então lhe perguntava
Com que genero de fé!
Suspensa a dama se vê;
Como nada respondeu,
Não pude saber o seu
Com que, porque, para que.

Persuado a crer o caso pelas suas circumstancias, e muito mais

quando vejo aqui umas reliquias mais separadas d’aquelle humor,
ou ramas menos fortes do enxerto do doutor Pedro de Mattos seu
tio, onde não ha resposta sem equivoco sem substancia do genero
mais nobre.
Foi o doutor Gregorio de Mattos de boa estatura, secco do corpo,
membros delicados, poucos cabellos e crespos, testa espaçosa,
sobrancelhas arqueadas, olhos garços, nariz aguilenho, bocca
pequena e engraçada, barba sem demasia, e no tracto cortezão.
Trajava commummente seu collete de pelles de ambar, volta de fina
renda, e era finalmente um composto de perfeições como poeta
portuguez, que são Esopos os de outras nações. Tinha phantasia
natural no passeio, e quando algumas vezes por recreação sulcava
os quietos mares da Bahia a remo compassado, com tão bizarra
confiança interpunha os oculos, examinando as janellas da sua
cidade, que muitos curiosos iam de proposito a vê-lo.
 Fiz tirar d’elle a presente cópia, por um antigo pintor, que foi seu
familiar, e conferindo-a com as memorias que d’elle têm algumas
pessoas antigas, tenho-a por mui conforme a seu original. Naquelle
tempo era pouco versado o uso das cabelleiras, e elle a trajava: mas
pareceu-me copia-lo sem ella, porque os homens de talento devem
patentear-nos as officinas capitaes que o produzem para informação
dos judiciosos.
SATYRICAS
 OBRAS POETICAS
DE
GREGORIO DE MATTOS GUERRA

AOS VICIOS
TERCETOS

Eu sou aquelle que os passados annos

Cantei na minha lyra maldizente
Torpezas do Brazil, vicios e enganos.

E bem que os descantei bastantemente,

Canto segunda vez na mesma lyra
O mesmo assumpto em plectro differente.

Já sinto que me inflamma e que me inspira

Thalia, que anjo é da minha guarda
Des’ que Apollo mandou que me assistira.

Arda Bayona, e todo o mundo arda,

Que a quem de profissão falta á verdade
Nunca a dominga das verdades tarda.

Nenhum tempo exceptua a christandade

Ao pobre pegureiro do Parnaso
Para fallar em sua liberdade.

A narração ha de egualar ao caso,

E si talvez ao caso não eguala,
Não tenho por poeta o que é Pegaso.

De que póde servir calar quem cala?

Nunca se ha de fallar o que se sente?!
Sempre se ha de sentir o que se falla.
Qual homem póde haver tão paciente,
Que, vendo o triste estado da Bahia,
Não chore, não suspire e não lamente?

Isto faz a discreta phantasia:

Discorre em um e outro desconcerto,
Condemna o roubo, increpa a hypocrisia.

O nescio, o ignorante, o inexperto,

Que não elege o bom, nem mau reprova,
Por tudo passa deslumbrado e incerto.

E quando vê talvez na doce trova

Louvado o bem, e o mal vituperado,
A tudo faz focinho, e nada approva.

Diz logo prudentaço e repousado:

—Fulano é um satyrico, é um louco,
De lingua má, de coração damnado.

Nescio, si d’isso entendes nada ou pouco,

Como mofas com riso e algazarras
Musas, que estimo ter, quando as invoco.

Si souberas fallar, tambem falláras,

Tambem satyrisáras, si souberas,
E si fôras poeta, poetisáras.

A ignorancia dos homens d’estas eras

Sizudos faz ser uns, outros prudentes,
Que a mudez canoniza bestas feras.

Ha bons, por não poder ser insolentes,

Outros ha comedidos de medrosos,
Não mordem outros não—por não ter dentes.
Quantos ha que os telhados têm vidrosos,
E deixam de atirar sua pedrada,
De sua mesma telha receiosos?

Uma só natureza nos foi dada;

Não creou Deus os naturaes diversos;
Um só Adão creou, e esse de nada.

Todos somos ruins, todos perversos,

Só nos distingue o vicio e a virtude,
De que uns são comensaes, outros adversos.

Quem maior a tiver, do que eu ter pude,

Esse só me censure, esse me note,
Calem-se os mais, chiton, e haja saude.
 BENZE-SE
O P. DE VARIAS ACÇÕES QUE OBSERVAVA NA SUA PATRIA

D’estes que campam no mundo

Sem ter engenho profundo,
E, entre gabos dos amigos,
Os vemos em papafigos
Sem tempestade, nem vento:
Anjo bento!

De quem com lettras secretas

Tudo o que alcança é por tretas,
Baculejando sem pejo,
Por matar o seu desejo,
Desde a manhãa té à tarde:
Deus me guarde!

Do que passeia farfante,

Muito presado de amante,
Por fóra luvas, galões,
Insignias, armas, bastões.
Por dentro pão bolorento:
Anjo bento!

D’estes beatos fingidos,

Cabisbaixos, encolhidos,
Por dentro fataes maganos,
Sendo nas caras uns Janos,
Que fazem do vicio alarde:
Deus me guarde!
 Que vejamos teso andar
Quem mal sabe engatinhar,
Muito inteiro e presumido,
Ficando o outro abatido
Com maior merecimento:
Anjo bento!

D’estes avaros mofinos,

Que põem na meza pepinos,
De toda a iguaria isenta,
Com seu limão e pimenta,
Porque diz que queima e arde:
Deus me guarde!

Que pregue um douto sermão

Um alarve, um asneirão;
E que esgrima em demasia
Quem nunca lá na Sophia[1]
Soube pôr um argumento:
Anjo bento!

[1] Rua principal de Coimbra: allusão á Universidade.

D’esse sancto emmascarado,

Que falla do meu peccado,
E se tem por Sancto Antonio,
Mas em luctas com o demonio
Se mostra sempre cobarde:
Deus me guarde!
Que atropellando a justiça,
Só com virtude postiça,
Se premeie o delinquente,
Castigando o innocente
Por um leve pensamento:
Anjo bento!
 REPROVAÇÕES

Si sois homem valoroso,

Dizem que sois temerario,
Si valente—espadanchim,
E atrevido si esforçado.
Si resoluto—arrogante,
Si pacifico, sois fraco,
Si precatado—medroso,
E si o não sois—confiado.
Si usaes justiça, um Herodes,
Si favoravel, sois brando,
Si condemnaes, sois injusto,
Si absolveis, estaes peitado.
Si vos dão, sois um covarde,
E si daes sois deshumano,
Si vos rendeis, sois traidor,
Si rendeis—afortunado.
Si sois plebeu, sois humilde,
Soberbo, si sois fidalgo,
Si sois segundo sois pobre,
E tolo si sois morgado.
Si galeaes, sois fachada,
E si não—não sois bizarro,
Si vestis bem, sois gram moda,
Si mal vestis sois um trapo.
Si comeis muito, guloso,
E faminto, si sois parco,
Si comeis bem, regalão,
E si mal, nunca sois farto.
Si não soffreis, imprudente,
Si soffreis sois um coitado,
Si perdoaes, sois bom homem,
E si não sois—um tyranno.
Si brioso, tendes fumos,
 E si não, sois homem baixo,
Si sois serio, descortez,
Si cortez, afidalgado.
Si defendeis, sois amigo,
Si o não fazeis sois contrario,
Si sois amigo, suspeito,
Si o não sois—affeiçoado.
Si obraes mal, sois ignorante,
Si bem obraes, foi acaso,
Si não servis, sois isento,
E si servis, sois criado.
Si virtuoso, fingido,
E hypocrita si beato,
Si zeloso, impertinente,
E si não, sois um patrano.
Si sois sisudo, intractavel,
Si sois devoto, sois falso,
Pertinaz, si deffendente,
Si arguinte, porfiado.
Si discreto, prevenido,
E si não, sois insensato,
Si sois modesto, sois simples,
E si o não sois, sois um diabo.
Si sois gracioso, sois fatuo,
E si não sois, um marmanjo,
Si sois agudo tresledes,
E si o não sois, sois um asno.
Si não compondes, sois nescio,
Si escreveis, sois censurado,
Si fazeis versos sois louco,
E si o não fazeis, sois parvo.
Si previsto, feiticeiro,
E si não, desmazelado,
Si verdadeiro, bom homem,
Muito humilde, si sois lhano.
Si robusto, sois grosseiro,
Si delicado, sois brando,
 Si descansado, ocioso,
Si para pouco, sois tranco.
Si sois gordo, sois balôfo,
Sois phthisico, si sois magro,
Si pequeno, sois anão,
E gigante, si sois alto.
Si sois nobre, sois pelão,
E si official, sois baixo,
Si solteiro—extravagante,
Si noivo sois namorado.
Si corado, figadal,
Descorado, si sois alvo,
Si grande nariz—judeu,
Si trigueiro, sois mulato.
Si liberal sois perdido,
E si o não sois, sois escasso,
Si sois prodigo, vicioso,
E avarento, si poupado.
Si não despendeis—mesquinho,
Si despendeis, sois mui largo,
Si não gastaes—miseravel,
Si gastaes—esperdiçado.
Si honesto sois, não sois homem,
... si sois casto,
Si não namoraes, .....
Si o fazeis, sois estragado.
Si não luzis, não sois gente,
Si luzis, sois mui presado,
Si pedis, sois pobretão,
E si não, fazeis Calvarios.
Si andaes devagar—mimoso,
Si depressa sois cavallo,
Mal encarado, si feio,
Si gentil—affeminado.
Si fallaes muito, palreiro,
Si fallaes pouco, sois tardo,
Si em pé, não tendes assento,
 Preguiçoso, si assentado.
E assim não póde viver
Neste Brazil infestado,
Segundo o que vos refiro
Quem não seja reprovado.
 VERDADES

Ouve, ó amigo João,

Esta verdade que canto,
Si a verdade causa espanto
Esta causa admiração:
É certo, sem remissão,
E contra isto não ha nada,
Que a outra verdade usada
Com rebuços, mais enganos,
É verdade de maganos,
Mas esta é de gente honrada.

Domingos e dias sanctos

Nos manda a egreja guardar,
Nos mais dias trabalhar:
As mulheres trazem mantos:
Os doutos estão nos cantos,
Os ignorantes na praça,
Os cachorros vão á caça,
Os gatos furtam as ceias,
Os barbeiros rasgam veias
E as padeiras fazem massa.

Os homens fazem a guerra,

E as mulheres fazem renda,
Os tolos não têm emenda,
Os capos cavam a terra:
O bezerro sem mãe berra
Batem bandeiras alferes,
Os pobres buscam haveres,
Os peixes nadam no mar,
As purgas fazem purgar,
E os franciscanos colhéres.
Os cavallos comem herva,
Os despidos andam nús,
Come o Gentio cajús,
Os Tapuyas são caterva:
Não dorme de noite a cerva,
Os macacos fazem momos,
Os escripturarios tomos,
Os namorados passeiam,
As fragonas zombeteiam,
E as limas todas têm gomos.

Todos os ferrões têm ponta,

A agua do mar é salgada,
O hóspede logo enfada,
Todo o algarismo é conta:
A nau sem vela não monta,
O badalo dá no sino,
Chorar muito é desatino,
Muito comer enche a pança,
Bum-bum é agua em criança
E ter em pé, pino-pino.

Os caranguejos têm pernas,

Tocado o tambor faz bulha,
O arrelá desempulha,
O navio tem cavernas;
O fogo accende as lucernas
Os ... fedem á ..,
Quem degenera não herda,
O carvão todo é de lenha,
É só de lã a estamenha,
E a cabelleira tem cerda.
As hervas são todas folhas,
As larangeiras dão fructas,
Mulheres damas são .. ..,
Uma talha são dez polhas:
As botijas levam rolhas,
Toda a neve é branca e fria,
A irmãa de mãe é tia,
É o bronze todo duro,
Onde não ha luz, é escuro,
Quando não é noite é dia.

O sol e o fogo são quentes,

A chuva aonde cae molha,
Quem não tem vista não olha,
Ossos na boca são dentes:
É affronta dizer—mentes!
É ave grande a gallinha,
O cabello cae com tinha,
Quem é rouco tem catarrho,
Carregado canta o carro,
Mulher de rei é rainha.

Não ha barba sem cabello,

A arêa toda é de grãos,
Toca-se a harpa com as mãos,
É animal o camello:
Nenhuma calva tem pello,
Os ovos saem pelo ..
É marisco o sururú,
Todo o feijão é legume,
Coze-se o comer ao lume,
É abobora o gerumú.
Todo o unguento é mézinha
Não tem banha o bacalhau,
Papas ralas é mingau,
Trigo moido é farinha:
Couza alheia não é minha,
Não ha escada sem degraus,
Os picaros são maraus,
Tem aduellas a pipa,
Umbigo é ponto de tripa,
Sempre é loio o rei de paus.

Primeiro foi frango o gallo,

Palangana é prato fundo,
É redondo todo o mundo,
As luvas não fazem callo:
Tem quatro pés o cavallo,
Nunca mija o papagaio,
O chouriço grande é paio,
Não sabe ler a guariba,
Quem tem carcunda tem giba,
Antes de junho está maio.

Todo o chapeu é sombreiro,

As arvores são de pau,
Tudo o que não presta é mau,
E faz a barba o barbeiro:
O.. detraz é trazeiro,
É nervo a penna de pato,
Filho de parda, é mulato,
Mulheres todas são femeas,
Duas em um ventre são gemeas,
No pé se calça o sapato.