bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical management of cerebral metastases from melanoma: outcome in 147 patients treated at a single institution over two decades
Authors: Zacest Andrew C. , Besser Michael , Stevens Graham , Thompson John F. , McCarthy William H. , Culjak Gordana
Published: May 2009

Object. The aim of this study was to review the outcome of patients who underwent surgery for treatment of cerebral metastatic melanoma.

Methods. A retrospective analysis was performed in 147 patients with cerebral metastases from melanoma who were treated surgically at a single institution between 1979 and 1999. Almost all patients underwent postoperative whole-brain radiation therapy. The mean patient age was 53 years (range 17–76 years); 69% of patients were male. A single cerebral metastasis was identified in 84% of patients, although 56% had synchronous extracranial metastases. The 30-day postoperative mortality rate was 2% and neurological symptoms resolved or improved in 78% of patients. Recurrence of intracerebral disease was seen in 55% of patients and 26% died of intracerebral metastases. Twenty-four patients underwent reoperation for recurrent cerebral disease. The median survival duration from the time of surgery for all patients was 8.5 months; the 3- and 5-year survival rates were 9% and 5%, respectively. Factors that significantly influenced survival on univariate analysis were the number of cerebral metastases (p = 0.015), a macroscopically complete excision (p < 0.05), and reoperation for recurrence (p = 0.02). The presence of extracranial metastases did not significantly influence survival. On multivariate analysis only the number of cerebral metastases significantly affected survival (p = 0.04).

Conclusions. For the majority of patients with cerebral metastases from melanoma, surgery with adjuvant radiation therapy is a treatment option that improves neurological symptoms and produces minimal morbidity. Long-term survival (> 3 years) most likely occurs in patients with a single cerebral metastasis and no demonstrable extracranial disease. Reoperation for recurrent cerebral disease may be appropriate in selected cases.
Chromosomal imbalances in primary oligodendroglial tumors and their recurrences: clues about malignant progression detected using comparative genomic hybridization
Authors: Jeuken Judith W. M. , Sprenger Sandra H. E. , Vermeer Harry , Kappelle Arnoud C. , Boerman Rudolf H. , Wesseling Pieter
Published: May 2009

Object. Despite the rapid increase in knowledge concerning the genetic basis of malignant progression in astrocytic tumors, progression of oligodendroglial tumors (including both pure oligodendrogliomas and mixed oligoastrocytomas) is still poorly understood. The aim of the present study is the elucidation of chromosomal imbalances involved in the progression of oligodendroglial tumors toward malignancy.

Methods. Using comparative genomic hybridization (CGH) on snap-frozen tumor tissue, the tumor genomes of five primary oligodendroglial tumors and associated recurrent tumors were screened for chromosomal imbalances. This information was correlated with clinical data (including follow-up data) and histopathological malignancy grade.

In all cases an increase in chromosomal imbalances was detected in the recurrent tumor, indicating genetic progression. In three of the five cases this correlated with malignant progression detected at the histopathological level. The results indicate that, similar to what occurs in astrocytic tumors, chromosomal imbalances harboring genes involved in the cell proliferation control mechanism at the G1-S border are involved in the progression of oligodendroglial tumors. Additionally, although gains of genetic material on chromosome 7 and losses on chromosome 10 are most frequently detected in the course of malignant progression of astrocytic tumors, either or both of these can also occur during malignant progression of typical oligodendroglial tumors that contain losses involving chromosome 1p and/or chromosome 19q.

Conclusions. When performed on optimally preserved material from a small set of primary oligodendroglial tumors and associated recurrent tumors, CGH detects chromosomal aberrations that potentially play a mechanistic role in the malignant progression of these tumors.
Intracranial meningeal melanocytoma associated with ipsilateral nevus of Ota
Authors: Piercecchi-Marti Marie-Dominique , Mohamed Hicham , Liprandi Agnes , Gambarelli Daniele , Grisoli Francois , Pellissier Jean-François
Published: May 2009

✓ In this report, the authors review the case of a man with a neurocutaneous syndrome. He presented with an intracerebral melanocytoma associated with a blue nevus of the scalp; its location and its appearance during childhood supported the diagnosis of a nevus of Ota.

Meningeal melanocytomas are increasingly being diagnosed, but remain rare. Primary meningeal malignant melanoma is the first differential diagnosis to eliminate.

Despite their common embryonic origin, the association of a melanocytoma with a nevus of Ota is rare. A nevus of Ota exhibits the same melanocytic proliferation and affects the trigeminal nerve territory. An ocular effect is not always observed. In contrast to an ocular lesion, a nevus of Ota rarely transforms into a malignant melanoma. It is found only among caucasians.

During 4 years of follow-up review after surgery, the patient remained asymptomatic. Other than antiepileptic therapy, he received no complementary treatment and cerebral imaging revealed no evidence of recurrence.
Subthalamic nucleus stimulation in patients with a prior pallidotomy
Authors: Mogilner Alon Y. , Sterio Djordje , Rezai Ali R. , Zonenshayn Martin , Kelly Patrick J. , Beric Aleksandar
Published: May 2009

Object. A substantial number of patients with Parkinson disease (PD) who have undergone unilateral stereotactic pallidotomy ultimately develop symptom progression, becoming potential candidates for further surgical treatment. Bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) has been shown to be effective in the treatment of a subset of patients with refractory PD. Microelectrode recording is performed to help localize the STN and guide final placement of the electrode. Potential alterations in physiological features of the STN after pallidotomy may complicate localization of this structure in this group of patients.

Methods. Bilateral STN DBS surgery guided by microelectrode recording was performed in six patients who had undergone previous unilateral pallidotomies. Physiologically obtained parameters of the STN, including trajectory length, mean firing rate, cell number, and cell density were calculated. These data were compared with those from the side without prior pallidotomy within each patient, as well as with those from our series of 49 subthalamic nuclei explored in 26 patients who had not undergone prior pallidotomy but who underwent bilateral STN stimulator placement.

In all patients, analysis of STN cellular activity on the side ipsilateral to the pallidotomy demonstrated a lower mean firing frequency than on the contralateral, intact side. The physiological features on the intact side were not significantly different from those found in our series of patients who had not undergone prior pallidotomy.

Conclusions. Physicians who perform STN surgery in patients with prior pallidotomy should be aware of the electrophysiological differences between the STN that had undergone pallidotomy and the one that had not, to avoid prolonging recording time to search for the typical STN. The implications of these findings for the current models of information processing in the basal ganglia are discussed.
Comparison of atlas- and magnetic resonance imaging—based stereotactic targeting of the globus pallidus internus in the performance of deep brain stimulation for the treatment of dystonia
Authors: Vayssiere Nathalie , Hemm Simone , Cif Laura , Christine Picot Marie , Diakonova Nina , El Fertit Hassan , Frerebeau Philippe , Coubes Philippe
Published: May 2009

Object. To assess the validity of relying on atlases during stereotactic neurosurgery, the authors compared target coordinates in the globus pallidus internus (GPi) obtained using magnetic resonance (MR) imaging with those determined using an atlas. The targets were used in deep brain stimulation (DBS) for the treatment of generalized dystonia.

Methods. Thirty-five patients, who were treated using bilateral DBS of the GPi, were included in this study. The target was selected on three-dimensional MR images by direct visual recognition of the GPi. The coordinates were automatically recorded using dedicated software. They were translated into the anterior commissure—posterior commissure (AC—PC) coordinate system by using a matrix transformation process. The same GPi target was defined, based on the locations of brain structures shown in the atlases of Schaltenbrand and Talairach. Magnetic resonance imaging—based GPi target coordinates were statistically compared with the corresponding atlas-based coordinates by applying the Student t-test.

A significant difference (p < 0.001) was demonstrated in x, y, and z directions between MR imaging—based and Schaltenbrand atlas—derived target coordinates. The comparison with normalized Talairach atlas coordinates demonstrated a significant difference (p < 0.01) in the y and z directions, although not in the x direction (p = 0.12).

No significant correlation existed between MR imaging—based target coordinates and patient age (p > 0.1). No significant correlation was observed between MR imaging—based target coordinates and patient sex in the y and z directions (p > 0.9), although it was significant in the x direction (p < 0.05). A significant variation in coordinates and the length of the AC—PC line was revealed only in the y direction (p < 0.005).

Conclusions. A significant difference was found between target coordinates obtained by direct visual targeting on MR images (validated by postoperative clinical results) and those obtained by indirect targeting based on atlases.
Integration of sulcal and functional information for multimodal neuronavigation
Authors: Jannin Pierre , Morandi Xavier , Fleig Oliver J. , Le Rumeur Elisabeth , Toulouse Pierre , Gibaud Bernard , Scarabin Jean-Marie
Published: May 2009

Object. The authors present the use of cortical sulci, segmented from magnetic resonance (MR) imaging, and functional data from functional (f)MR imaging and magnetoencephalography (MEG) in the image-guided surgical management of lesions adjacent to the sensorimotor cortex.

Methods. In an initial set of 11 patients, sulci near lesions were automatically segmented from MR imaging data sets, then MEG and fMR imaging examinations were performed. Relevant functional information was preoperatively interpreted and selected from MEG and fMR imaging and subsequently transferred to the navigation system for selected sulci. A neuronavigation system consisting of a surgical microscope with enhanced reality overlay display was used. Data were displayed as contours on the cut-plane images of a stereotactic workstation and as contours on the overlay screen of the head-up display within the optical path of the right eyepiece of the surgical microscope.

Conclusions. This method, in which both sulcal and functional mapping are used for surgery planning and neuronavigation, provides helpful information. It is a promising procedure for the treatment of patients who harbor lesions in areas around the eloquent cortex.
Clinical application of a new bioabsorbable artificial dura mater
Authors: Yamada Keisuke , Miyamoto Susumu , Takayama Motohiro , Nagata Izumi , Hashimoto Nobuo , Ikada Yoshito , Kikuchi Haruhiko
Published: May 2009

Object. In their pursuit of a better substitute for dura mater in neurosurgical procedures, the authors review their experience with GM972.

Methods. A newly developed synthetic dural substitute composed of bioabsorbable polymers (GM972) was placed in 53 patients during neurosurgical procedures. The handling properties of the material, surgical wound features, and findings of hematological, computerized tomography, and/or magnetic resonance imaging examinations were evaluated. The average follow-up period was 35.5 months. The handling properties and biocompatibility of this new dural substitute were highly satisfactory, and no significant complication was observed. In patients who underwent a second surgery performed more than 18 months after the initial operation, this new dural substitute was found to have been replaced by autologous collagenous tissue. Because of its bioabsorbability, chronic foreign body reactions to this synthetic dural substitute were negligible.

Conclusions. In this report the authors support the effectiveness and safety of this bioabsorbable artificial dural substitute that provides a reduced risk of transmission of latent infection.
Normal changes in orbital volume during childhood
Authors: Bentley Robert P. , Sgouros Spyros , Natarajan Kalyan , Dover M. Stephen , Hockley Anthony D.
Published: May 2009

Object. The aim of this study was to construct a model of changes in orbital volume that occur throughout childhood from the age of 1 month to 15 years, which could be used for comparative studies of disease states affecting orbital growth.

Methods. Using the procedure of segmentation on magnetic resonance images obtained in 67 healthy children, orbital volume was measured and plotted against age.

During the first few months of life left orbital volume is on average 15 cm3 in male and 13 cm3 in female infants; these volumes increase to 26 cm3 and 24 cm3, respectively, by the time the child reaches 15 years of age. During the first few months of life right orbital volume is on average 16 cm3 in male and 13 cm3 in female infants; these volumes increase to 27 cm3 and 25 cm3, respectively, by the time the child is 15 years old. This represents an overall increase in orbital volume by a factor of 1.7 in boys and 1.8 in girls. By the time the child has reached 5 years of age, the orbital volume for both right and left sides has reached on average 77% of the volume seen at 15 years in both sexes. The differences between the two sides are not statistically significant for either sex. The change in orbital volume that is associated with age in general displays a linear pattern. Throughout childhood, orbital volumes are larger in boys than in girls, but share a similar growth pattern. The difference between the two sexes tends toward statistical significance during the first 5 years of life (left orbit p = 0.1, right orbit p = 0.04).

Conclusions. During early childhood, orbital volume increases in a linear fashion, achieving a significant proportion of its final growth by the time the child is 5 years old.
Changes in orbital volume during childhood in cases of craniosynostosis
Authors: Bentley Robert P. , Sgouros Spyros , Natarajan Kalyan , Dover M. Stephen , Hockley Anthony D.
Published: May 2009

Object. Controversy remains concerning the timing of frontoorbital advancement (FOA) surgery performed for craniosynostosis. Reduced orbital volume and degree of exorbitism are often cited as reasons for early surgical intervention. To date, however, little attention has been given to orbital volume and its changes during the first few years of life as an indicator of orbital growth in children with craniosynostosis. Knowledge of orbital volume and growth patterns in individuals with craniosynostosis and those with normal cranial structures will enable surgeons to refine both the type and timing of surgical intervention required, thus obtaining the optimum outcome for their patients.

Methods. Using the procedure of segmentation, orbital volumes in 50 children with various forms of craniosynostosis were measured on preoperative computerized tomography scans. Changes in average volume that occur with increasing age were calculated and compared with a model of normal orbital volume growth. At presentation the children with craniosynostosis ranged in age from 1 to 29 months, with 82% of them within the 1st year of life.

Several interesting observations emerged from this study. Excluding patients with unilateral coronal synostosis, there was no difference between orbital volumes measured on the right and left sides, allowing mean orbital volume measurements to be used for comparative purposes. Although children with craniosynostosis begin life with significantly smaller orbital volumes, overall normal mean volumes for both sexes are attained by 13 months of age, with volumes approaching normal by 6 months of age in male infants and by 8 months of age in female infants. Changes in orbital volume associated with age generally appear to be similar in most forms of craniosynostosis. There appears to be no significant difference in changes in orbital volume between children with syndromic or nonsyndromic forms of bicoronal synostosis. Orbital volume is significantly reduced on the ipsilateral affected side in cases of unicoronal synostosis in comparison with the contalateral side, but it is not significantly lower than that of normal. Finally, FOA surgery appears to restore normal growth of orbital volume.

Conclusions. The results of this study indicate that the underlying mechanism leading to craniosynostosis and restriction of orbital volume “burns out” and begins to lose its major effects within the first few months of life. It would appear that FOA surgery should be delayed until the end of the second half of the 1st year of life, thus maximizing the effects of accelerated normal orbital growth and reducing the risks of relapse.
Endoscope-assisted clipping of a superior hypophyseal artery aneurysm without removal of the anterior clinoid process
Authors: Kinouchi Hiroyuki , Futawatari Katsuya , Mizoi Kazuo , Higashiyama Naoki , Kojima Hisashi , Sakamoto Tetsuya
Published: May 2009

✓ A 47-year-old man presented with a superior hypophyseal artery aneurysm and an ipsilateral posterior communicating artery aneurysm. Both lesions were successfully clipped without removal of the anterior clinoid process or retraction of the optic nerve by using endoscopic guidance. The endoscope was introduced into the prechiasmatic cistern and provided a clear visual field around the aneurysm that could not be seen via the operating microscope. The endoscope was useful in the identification of the medially projecting lesion and the small perforating branches of the ophthalmic segment of the internal carotid artery. A fenestrated clip could be introduced around the neck of the aneurysm and placed in the best position under endoscopic guidance. Endoscopy-assisted clipping is potentially a very useful procedure for aneurysm surgery.
Long-term pallidal deep brain stimulation in patients with advanced Parkinson disease: 1-year follow-up study
Authors: Loher Thomas J. , Burgunder Jean-Marc , Pohle Thomas , Weber Sabine , Sommerhalder Regine , Krauss Joachim K.
Published: May 2009

Object. The goal of this study was to investigate the efficacy of long-term deep brain stimulation (DBS) of the posteroventral lateral globus pallidus internus (GPi) accomplished using a single-contact monopolar electrode in patients with advanced Parkinson disease (PD).

Methods. Sixteen patients suffering from severe PD and levodopa-induced side effects such as dyskinesias and on—off fluctuations were enrolled in a prospective study protocol. There were six women and 10 men and their mean age at surgery was 65 years. All patients underwent implantation of a monopolar electrode in the posteroventral lateral GPi. Initially, nine patients received unilateral stimulation. Three of these patients underwent contralateral surgery at a later time. Ten patients received bilateral stimulation (contemporaneous bilateral surgery was performed in seven patients and staged bilateral surgery in the three patients who had received unilateral stimulation initially). Formal assessments were performed during both off-medication and on-medication (levodopa) periods preoperatively, and at 3 and 12 months postoperatively. There were no serious complications related to surgery or to DBS. Two transient adverse events occurred: in one patient a small pallidal hematoma developed, resulting in a prolonged micropallidotomy effect, and in another patient a subcutaneous hemorrhage occurred at the site of the pacemaker. In patients who received unilateral DBS, the Unified Parkinson's Disease Rating Scale activities of daily living (ADL) score during the off-levodopa period decreased from 30.8 at baseline to 20.4 at 3 months (34% improvement) and 20.6 at 12 months (33% improvement) postoperatively. The motor score during the off period improved from 57.2 at baseline to 35.2 at 3 months (38% improvement) and 35.3 at 12 months (38% improvement) postoperatively. Bilateral DBS resulted in a reduction in the ADL score during the off period from 34.9 at baseline to 22.3 at 3 months (36% improvement) and 22.9 at 12 months (34% improvement). The motor score for the off period changed from 63.4 at baseline to 40.3 at 3 months (36% improvement) and 37.5 at 12 months (41% improvement). In addition, there were significant improvements in patients' symptoms during the on period and in on—off motor fluctuations.

Conclusions. Pallidal DBS accomplished using a monopolar electrode is a safe and effective procedure for treatment of advanced PD. Compared with pallidotomy, the advantages of pallidal DBS lie in its reversibility and the option to perform bilateral surgery in one session. Comparative studies in which DBS is applied to other targets are needed.
Why do chronic subdural hematomas continue to grow slowly and not coagulate? Role of thrombomodulin in the mechanism
Authors: Murakami Hideki , Hirose Yuichi , Sagoh Masachika , Shimizu Kazuhiro , Kojima Masaru , Gotoh Kazuhiro , Mine Yutaka , Hayashi Takuro , Kawase Takeshi
Published: May 2009

Object. Thrombomodulin is a thrombin receptor on vascular endothelial cells that is highly expressed when these cells are injured, and it has anticoagulating activity. The authors investigated thrombomodulin expression to clarify why chronic subdural hematomas (CSDHs) continue to grow slowly, like a tumor, and are liquefied.

Methods. Burr hole craniotomy and drainage were performed in all 35 patients with CSDH who were included in the study. The plasma-soluble thrombomodulin and blood clotting factor values were determined in the hematoma and in peripheral blood. In the seven most recent cases, the plasma-soluble thrombomodulin values were determined in the residual hematoma collected from the drainage tube the day after surgery. The outer membranes of the CSDH that were obtained as specimens at operation were stained with monoclonal antibody against thrombomodulin for immunohistochemical studies. The plasma-soluble thrombomodulin values were higher (p < 0.0001), and conversely the values for factors V and VIII were lower in the hematoma than in peripheral blood (p < 0.0001). The plasma-soluble thrombomodulin values were lower in the residual hematomas than in the same lesions at operation (p = 0.018). The endothelial cells on the sinusoidal vessels exhibited immunoreactivity with thrombomodulin antibody in 28 (93%) of 30 cases.

Conclusions. The thrombomodulin is expressed on the sinusoidal vessels, and the blood coagulation system is inhibited in the hematoma. These findings indicate that these vessels are continuously injured and fail to heal. As a result, the bleeding from the sinusoidal vessels may persist, and the hematoma may grow slowly and fail to coagulate. It is suspected that transmitted pulsation variations in the hematoma cavity generate sinusoidal vessel injury.
Convection-enhanced delivery into the rat brainstem
Authors: Sandberg David I. , Edgar Mark A. , Souweidane Mark M.
Published: May 2009

Object. Convection-enhanced delivery (CED) can be used safely to achieve high local infusate concentrations within the brain and spinal cord. The use of CED in the brainstem has not been previously reported and may offer an alternative method for treating diffuse pontine gliomas. In the present study the authors tested CED within the rat brainstem to assess its safety and establish distribution parameters.

Methods. Eighteen rats underwent stereotactic cannula placement into the pontine nucleus oralis without subsequent infusions. Twenty rats underwent stereotactic cannula placement followed by infusion of fluorescein isothiocyanate (FITC)—dextran at a constant rate (0.1 µl/minute) until various total volumes of infusion (Vis) were reached: 0.5, 1, 2, and 4 µl. Additional rats underwent FITC—dextran infusion (Vi 4 µl) and were observed for 48 hours (five animals) or 14 days (five animals). Serial (20-µm thick) brain sections were imaged using confocal microscopy with ultraviolet illumination, and the volume of distribution (Vd) was calculated using computer image analysis. Histological analysis was performed on adjacent sections.

No animal exhibited a postoperative neurological deficit, and there was no histological evidence of tissue disruption. The Vd increased linearly (range 15.4–55.8 mm3) along with increasing Vi, with statistically significant correlations for all groups that were compared (p < 0.022). The Vd/Vi ratio ranged from 14 to 30.9. The maximum cross-sectional area of fluorescence (range 9.8–20.9 mm2) and the craniocaudal extent of fluorescence (range 2.8–5.1 mm) increased with increasing Vi.

Conclusions. Convection-enhanced delivery can be safely applied to the rat brainstem with substantial and predictable Vds. This study provides the basis for investigating delivery of various candidate agents for the treatment of diffuse pontine gliomas.
Persistent accumulation of cyclooxygenase-1—expressing microglial cells and macrophages and transient upregulation by endothelium in human brain injury
Authors: Schwab Jan M. , Beschorner Rudi , Meyermann Richard , Gözalan Fatma , Schluesener Hermann J.
Published: May 2009

Object. Secondary damage after central nervous system (CNS) injury is driven in part by oxidative stress and CNS inflammation and is substantially mediated by cyclooxygenases (COXs). To date, the rapidly inducible COX-2 isoform has been primarily linked to inflammatory processes, whereas expression of COX-1 is confined to physiological functions. The authors report the differential localization of COX-1 in human traumatic brain injury (TBI).

Methods. Differential cellular COX-1 protein expression profiles were analyzed following TBI in 31 patients and compared with neuropathologically unaltered control brains by using immunohistochemistry.

In these patients with TBI, a significant increase of COX-1 protein expression by vessel endothelial and smooth-muscle cells and CD68+ microglia/macrophages was observed to be strictly confined to the lesion. Accumulation of COX-1+ microglia/macrophages in the lesion was already evident 6 hours postinjury, reaching maximal levels after several weeks and remaining elevated at submaximal levels for several months after injury. Furthermore, COX-1+ cell clusters were located in the Virchow—Robin space during the leukocyte infiltration period from Days 4 to 8 after TBI. Double-labeling experiments confirmed coexpression of COX-1 by CD68+ microglia/macrophages. The numbers of COX-1+ vessel endothelial and smooth-muscle cells increased from Day 1, remaining at submaximal levels for months after injury.

Conclusions. The prolonged accumulation of COX-1+ microglia/macrophages that were restricted to perilesional areas affected by the acute inflammatory response points to a role of COX-1 in secondary injury. The authors have identified localized, accumulated COX-1 expression as a potential pharmacological target following TBI. Their results challenge the current paradigms of a selective COX-2 role in the postinjury inflammatory response.
Aberrant nuclear factor-κB activity and its participation in the growth of human malignant astrocytoma
Authors: Nagai Shoichi , Washiyama Kazuo , Kurimoto Masanori , Takaku Akira , Endo Shunro , Kumanishi Toshiro
Published: May 2009

Object. It has been suggested that nuclear factor (NF)-κB, a pleiotropic transcription factor, controls cell proliferation. The authors examined NF-κB activity and its participation in the growth of human malignant astrocytoma.

Methods. The authors examined NF-κB activity in human malignant astrocytoma cell lines and high-grade astrocytoma tissues by using electrophoretic mobility shift assays and immunohistochemical studies, respectively. In addition, messenger (m)RNA expression of p50 and RelA, which are representative subunits of NF-κB, and IκBα, which is a representative inhibitory protein of NF-κB, were analyzed using Northern blot hybridization in the astrocytoma cell lines. Furthermore, alterations in DNA synthesis and cell growth in the astrocytoma cell lines were examined after inhibition of NF-κB activity by RelA antisense oligodeoxynucleotide. The authors found NF-κB activity in all astrocytoma cell lines and high-grade astrocytoma tissues that were examined, but not in the fetal astrocyte strain or in normal cerebral tissue. Expression of p50, RelA, and IκBα mRNA was found in the fetal astrocyte strain and normal adult brain tissue, in addition to the astrocytoma cell lines. The relative levels of expression of these mRNAs were similar among these cell lines, the cell strain, and normal tissue. The RelA antisense oligodeoxynucleotide specifically reduced the levels of RelA mRNA expression and NF-κB activity in the astrocytoma cell lines, thus significantly inhibiting their DNA synthesis and cell growth.

Conclusions. Human malignant astrocytoma cells have aberrant NF-κB activity, which promotes their growth. This activity is not associated with aberrant expression of p50 and RelA.
Real-time detection of vascular occlusion and reperfusion of the brain during surgery by using infrared imaging
Authors: Watson Joseph C. , Gorbach Alexander M. , Pluta Ryszard M. , Rak Ramin , Heiss John D. , Oldfield Edward H.
Published: May 2009

Object. Application of sensitive infrared imaging is ideally suited to observe blood vessels and blood flow in exposed organs, including the brain. Temporary vascular occlusion is an important part of neurosurgery, but the capacity to monitor the effects of these occlusions in real time is limited. In surgical procedures that require vascular manipulation, such as those involving aneurysms, arteriovenous malformations (AVMs), or tumors, the ability to visualize blood flow in vessels and their distribution beds would be beneficial. The authors recount their experience in the use of a sensitive (0.02°C), high-resolution (up to 50 µm/pixel) infrared camera with a rapid shutter speed (up to 2 msec/frame) for localizing cortical function intraoperatively. They observed high-resolution images of cerebral arteries and veins.

The authors hypothesized that infrared imaging of cerebral arteries, performed using a sensitive, high-resolution camera during surgery, would permit changes in arterial flow to be be seen immediately, thus providing real-time assessment of brain perfusion in the involved vascular territory.

Methods. Cynomolgus monkeys underwent extensive craniectomies, exposing the frontal, parietal, and temporal lobes. Temporary occlusions of the internal carotid artery and middle cerebral artery branches (30 events) were performed serially and were visualized with the aid of an infrared camera.

Arteries and veins of the monkey brain were clearly visualized due to cooling of the exposed brain, which contrasted with blood within the vessels that remained at core temperature. Blood flow changes in vessels were seen immediately (< 1 second) in real time during occlusion and reopening of the vessels, regardless of the duration of the occlusion. Areas of decreased cortical blood flow rapidly cooled (−0.3 to 1.3°C) and reheated in response to reperfusion. Rewarming occurred faster in arteries than in the cortex (for a 20-minute occlusion, the change in temperature per second was 2 × 10−2°C in the artery and 7 × 10−3°C in the brain). Collateral flow could be evaluated by intraoperative observations and data processing.

Conclusions. Use of high-resolution, digital infrared imaging permits real-time visualization of arterial flow. It has the potential to provide the surgeon with a means to assess collateral flow during temporary vessel occlusion and to visualize directly the flow in parent arteries or persistent filling of an aneurysm after clipping. During surgery for AVMs, the technique may provide a new way to assess arterial inflow, venous outflow, results of embolization, collateral flow, steal, and normal perfusion pressure breakthrough.
Application of recombinant activated factor VII during surgery for a giant skull base hemangiopericytoma to achieve safe hemostasis
Authors: Gerlach Rüdiger , Marquardt Gerhard , Wissing Heimo , Scharrer Inge , Raabe Andreas , Seifert Volker
Published: May 2009

✓ The authors report on a 64-year-old woman with a huge recurrent skull base hemangiopericytoma, in whom they encountered severe difficulty in attaining intraoperative hemostasis. Standard surgical hemostatic methods and the administration of fresh-frozen plasma and prothrombin complex concentrates failed to stop diffuse bleeding from an inoperable tumor remnant. At a critical point during the operation, the intravenous administration of recombinant activated factor VII, combined with mechanical compression, finally led to satisfactory hemostasis. The rationale for using recombinant activated factor VII in situations of uncontrolled bleeding during neurosurgical procedures is discussed, along with the literature in which the use of recombinant activated factor VII as a maneuver of last resort is reported for hemostasis in other surgical fields.
Self-inflicted vocal cord paralysis in two patients with vagus nerve stimulators
Authors: Kalkanis James G. , Krishna Priya , Espinosa Jose A. , Naritoku Dean K.
Published: May 2009

✓ Vagus nerve stimulation for treatment of epilepsy is considered safe; reports of severe complications are rare. The authors report on two developmentally disabled patients who experienced vocal cord paralysis weeks after placement of a vagus nerve stimulator. In both cases, traction injury to the vagus nerve resulting in vocal cord paralysis was caused by rotation of the pulse generator at the subclavicular pocket by the patient. Traumatic vagus nerve injury caused by patients tampering with their device has never been reported and may be analogous to a similar phenomenon reported for cardiac pacemakers in the literature. As the use of vagus nerve stimulation becomes widespread it is important to consider the potential for this adverse event.
Intraosseous dural arteriovenous fistula of the skull base associated with hearing loss
Authors: Kim Myoung Soo , Oh Chang Wan , Han Dae Hee , Kwon O-Ki , Jung Hee-Won , Han Moon Hee
Published: May 2009

✓ The most common clinical presentations of dural arteriovenous fistulas (DAVFs) are bruit, headache, increased intracranial pressure, and intracranial hemorrhage. In particular locations, such as the cavernous sinus or middle cranial fossa, cranial nerve involvement due to dural arterial steal or venous occlusion may develop. A case in which a DAVF is associated with hearing loss, however, has not previously been reported. The authors report a case in which an intraosseous DAVF and associated hearing loss probably resulted from cochlear nerve or vascular compression caused by the draining vein or nidus of the DAVF.
Bilateral subdural effusion and cerebral displacement associated with spontaneous intracranial hypotension: diagnostic and management strategies
Authors: Hejazi Nedal , Al-Witry Muder , Witzmann Alfred
Published: May 2009

✓ The authors describe two patients with bilateral subdural effusion and cerebral displacement associated with spontaneous intracranial hypotension (SIH) and discuss the possible pathophysiological origins of these abnormalities. The signs seen on magnetic resonance imaging in both cases, such as tonsillar descent, subdural effusion, meningeal enhancement, downward displacement of the optic chiasm, and crowding of this structure and the hypothalamus between the pituitary gland and brain, can help to establish the diagnosis of SIH. Therapy with a lumbar epidural blood patch resulted in the rapid resolution of all symptoms and most morphological abnormalities. The authors propose diagnostic and management strategies based on their own experiences and the reported cases of SIH in the medical literature.
Osteosarcoma and fibrosarcoma caused by postoperative radiotherapy for a pituitary adenoma
Authors: Gnanalingham Kanna K. , Chakraborty Aabir , Galloway Malcolm , Revesz Tamas , Powell Michael
Published: May 2009

✓ Sarcomatous change is a rare complication of postoperative radiotherapy for pituitary adenomas. The authors report on what they believe to be the first case in which fibrosarcoma and, later, osteosarcoma developed during a 14-year period following surgery and radiotherapy for a nonsecreting pituitary macroadenoma.
Anterior paraclinoid aneurysms
Authors: Kinouchi Hiroyuki , Mizoi Kazuo , Nagamine Yoshihide , Yanagida Noritaka , Mikawa Shigeki , Suzuki Akira , Sasajima Toshio , Yoshimoto Takashi
Published: May 2009

Object. The characteristics of a previously unclassified paraclinoid aneurysm arising from the anterolateral (dorsal) wall of the proximal internal carotid artery were retrospectively analyzed in seven patients (five women and two men) who were treated surgically for an aneurysm in this unusual location.

Methods. One patient presented with subarachnoid hemorrhage (SAH) caused by rupture of this aneurysm. The lesions were found incidentally (five cases) or during investigation of SAH due to another aneurysm (one case). There was a female predominance in this series; all female patients harbored multiple aneurysms. All patients underwent surgery. Removal of the anterior clinoid process was necessary because the proximal neck of the aneurysm was closely adjacent to the dural ring.

Conclusions. This special group of aneurysms is very rare, is located exclusively in the intradural space, and carries the risk of SAH. The results of surgical treatment for this aneurysm are quite satisfactory.
High risk of acute deterioration in patients harboring symptomatic colloid cysts of the third ventricle
Authors: de Witt Hamer Philip C. , Verstegen Marco J. T. , De Haan Rob J. , Vandertop W. Peter , Thomeer Ralph T. W. M. , Mooij Jan J. A. , van Furth Wouter R.
Published: May 2009

Object. Patients harboring colloid cysts of the third ventricle can present with acute neurological deterioration, or the first indication of the lesion may appear when the patient suddenly dies. The risk of such an occurrence in a patient already identified as harboring a colloid cyst is unknown. The goal of this study was to estimate the risk of acute deterioration in patients with colloid cysts.

Methods. A retrospective study was made of a cohort of patients with newly diagnosed colloid cysts who were recruited in The Netherlands between January 1, 1993, and December 31, 1997. Seventy-eight patients were identified, all of whom displayed symptoms. Twenty-five patients (32%) presented with symptoms of acute deterioration; four patients died suddenly and the cysts were discovered at autopsy. The overall mortality rate was 12%. Results of a multivariate logistic regression analysis demonstrated that no subgroup of patients presenting without acute deterioration could be identified on the basis of patient age, duration of symptoms, cyst size, or the presence of hydrocephalus. The national incidence of colloid cysts in The Netherlands is 1/106 person-years; the prevalence was estimated to be 1800 asymptomatic colloid cysts.

Conclusions. Acute deterioration was a frequent presentation among a national cohort of Dutch patients harboring symptomatic colloid cysts. The risk of acute deterioration in a symptomatic patient with a colloid cyst in The Netherlands is estimated to be 34%. The estimated risk for an asymptomatic patient with an incidental colloid cyst is significantly lower. These results strongly advocate the selection of surgical treatment for patients with symptomatic colloid cysts.
Multichannel auditory brainstem implant: update on performance in 61 patients
Authors: Otto Steven R. , Brackmann Derald E. , Hitselberger William E. , Shannon Robert V. , Kuchta Johannes
Published: May 2009

Object. Neurofibromatosis Type 2 (NF2) has typically resulted in deafness after surgical removal of bilateral vestibular schwannomas (VSs). Cochlear implants are generally ineffective for this kind of deafness because of the loss of continuity in the auditory nerve after tumor removal. The first auditory brainstem implant (ABI) in such a patient was performed in 1979 at the House Ear Institute, and this individual continues to benefit from electrical stimulation of the cochlear nucleus complex. In 1992, an advanced multichannel ABI was developed and a series of patients with NF2 received this implant to study the safety and efficacy of the device.

Methods. At the time of first- or second-side VS removal, patients received an eight-electrode array applied to the surface of the cochlear nucleus within the confines of the lateral recess of the fourth ventricle. The device was activated approximately 6 weeks after implantation, and patients were tested every 3 months for the 1st year after the initial stimulation, and annually thereafter. The protocol included a comprehensive battery of psychophysical and speech perception tests.

Conclusions. The multichannel ABI proved to be effective and safe in providing useful auditory sensations in most patients with NF2. The ABI improved patients' ability to communicate compared with the lipreading-only condition, it allowed the detection and recognition of many environmental sounds, and in some cases it provided significant ability to understand speech by using just the sound from the ABI (with no lipreading cues). Its performance in most patients has continued to improve for up to 8 years after implantation.
Correlation between changes in apparent diffusion coefficient and induction of heat shock protein, cell-specific injury marker expression, and protein synthesis reduction on diffusion-weighted magnetic resonance images after temporary focal cerebral ischemia in rats
Authors: Kokubo Yasuaki , Matson Gerald B. , Liu Jialing , Mancuso Anthony , Kayama Takamasa , Sharp Frank R. , Weinstein Philip R.
Published: May 2009

Object. The authors investigated the relationship between the time course of apparent diffusion coefficient (ADC) changes and stress protein induction, ischemic neuroglial damage, and cerebral protein synthesis (CPS) after temporary focal cerebral ischemia in rats.

Methods. In Group I, ADC changes were measured on magnetic resonance (MR) images obtained during the second half of a 1-hour middle cerebral artery (MCA) occlusion, during a 1-hour reperfusion, and after 23 hours of reperfusion in rats. Immunohistochemical studies for heat shock protein (hsp) 70, glial fibrillary acidic protein (GFAP), and neuronal nuclear (NeuN) protein were performed. In Group II, CPS was assessed using autoradiographic studies obtained after occlusion.

At 36 minutes of occlusion, MR imaging demonstrated significantly less ADC reduction in the frontoparietal cortex (82 ± 9% of the contralateral hemisphere) than in the striatum (64 ± 11%; p < 0.05). After 1 hour of reperfusion, the lesion resolved and the difference between cortex and striatum was no longer evident. After 23 hours of reperfusion, the ADC lesion recurred in striatum (76 ± 12%) compared with frontoparietal cortex (100 ± 11%; p < 0.05). Immunohistochemical studies showed hsp 70 expression and an increased GFAP reactivity localized in the frontoparietal cortex of the ischemic hemisphere, along with a significant drop in striatal NeuN immunoreactivity. A trend toward greater reduction in striatal CPS (53 ± 15%) than in frontoparietal cortex CPS (78 ± 23%) was also observed.

Conclusions. Sequential ADC maps correlate with the expression of neuroglial stress and injury markers after temporary focal ischemia in rats, distinguishing the striatum (infarct core) from the cortex (ischemic penumbra). A greater reduction in striatal CPS further supports the conclusion that the striatum is more susceptible to temporary MCA occlusion than the cortex.
Detailed anatomy of the intracranial segment of the hypoglossal nerve: neurovascular relationships and landmarks on magnetic resonance imaging sequences
Authors: Yousry Indra , Moriggl Bernhard , Schmid Urs D. , Wiesman Martin , Fesl Gunther , Brückmann Hartmut , Naidich Thomas P. , Yousry Tarek A.
Published: May 2009

Object. The thin hypoglossal nerve can be very difficult to distinguish on magnetic resonance (MR) images. The authors used a combination of sequences to increase the reliability of MR imaging in its demonstration of the 12th cranial nerve as well as to assess the course of the nerve, display its relationships to adjacent vessels, and provide landmarks for evaluating the nerve in daily practice.

Methods. The study group consisted of 34 volunteers (68 nerves) in whom a three-dimensional (3D) Fourier-transformation constructive interference in steady-state (CISS) sequence and a 3D T1-weighted contrast-enhanced magnetization-prepared rapid-acquisition gradient-echo (MPRAGE) sequence were applied. Two trained neuroradiologists collaboratively identified the hypoglossal trigone, preolivary sulcus, 12th cranial nerve, posterior inferior cerebellar artery, vertebral artery, 12th nerve root sleeve, and the hypoglossal canal on each side.

The 3D CISS sequence successfully demonstrated the hypoglossal trigone (100% of images), 12th nerve root bundles (100% of images), and 12th nerve sleeves (88.2% of images). The canalicular segment was exhibited with the aid of plain 3D CISS sequences in 74% of images and by using contrast-enhanced 3D CISS sequences and contrast-enhanced MPRAGE sequences in 100% of images. The landmarks that proved useful to identify the cisternal segment of the 12th cranial nerve included the hypoglossal trigone, preolivary sulcus, and 12th nerve root sleeve. Neurovascular contact was identified in 61% of root bundles. The roots were distorted in 44% of these contacts.

Conclusions. The contrast-enhanced 3D CISS sequence consistently displayed the cisternal segment as well as the canalicular segments of the hypoglossal nerve and is, therefore, the best sequence to visualize the complete cranial course of this nerve. Landmarks such as the 12th nerve sleeves can assist in the identification of this nerve.
Stereotactic radiosurgery providing long-term tumor control of cavernous sinus meningiomas
Authors: Lee John Y. K. , Niranjan Ajay , McInerney James , Kondziolka Douglas , Flickinger John C. , Lunsford L. Dade
Published: May 2009

Object. To evaluate long-term outcomes of patients who have undergone stereotactic radiosurgery for cavernous sinus meningiomas, the authors retrospectively reviewed their 14-year experience with these cases.

Methods. One hundred seventy-six patients harbored meningiomas centered within the cavernous sinus. Seventeen patients were lost to follow-up review, leaving 159 analyzable patients, in whom 164 procedures were performed. Seventy-six patients (48%) underwent adjuvant radiosurgery after one or more attempts at surgical resection. Eighty-three patients (52%) underwent primary radiosurgery. Two patients (1%) had previously received fractionated external-beam radiation therapy. Four patients (2%) harbored histologically verified atypical or malignant meningiomas. Conformal multiple isocenter gamma knife surgery was performed. The median dose applied to the tumor margin was 13 Gy.

Neurological status improved in 46 patients (29%), remained stable in 99 (62%), and eventually worsened in 14 (9%). Adverse effects of radiation occurred after 11 procedures (6.7%). Tumor volumes decreased in 54 patients (34%), remained stable in 96 (60%), and increased in nine (6%). The actuarial tumor control rate for patients with typical meningiomas was 93.1 ± 3.3% at both 5 and 10 years. For the 83 patients who underwent radiosurgery as their sole treatment, the actuarial tumor control rate at 5 years was 96.9 ± 3%.

Conclusions. Stereotactic radiosurgery provided safe and effective management of cavernous sinus meningiomas. We believe it is the preferred management strategy for tumors of suitable volume (average tumor diameter ≤ 3 cm or volume ≤ 15 cm3).