bluuebunny/crossref_metadata_2025 huggingface dataset:
Simulation of the natural history of cerebral aneurysms based on data from the International Study of Unruptured Intracranial Aneurysms
Authors: Chang Han Soo
Published: January 2008

Object

Despite recent publications of large-scale study data, controversy over the management of unruptured cerebral aneurysms continues. The low rupture rates in the International Study of Unruptured Intracranial Aneurysms (ISUIA) apparently contradicted surgeons’ experiences with ruptured aneurysms. In the present study, based on data from the ISUIA, a mathematical model describing the natural history of cerebral aneurysms was developed. With this model, the author aimed to examine the validity of data from the ISUIA and to provide a better treatment guideline for unruptured aneurysms.

Methods

The author made a computer simulation of the natural history of cerebral aneurysms that was used to calculate such figures as the prevalence of unruptured aneurysms, incidence of subarachnoid hemorrhage (SAH), and age and size distribution of both unruptured and ruptured aneurysms. The lifetime lesion rupture probability for individual patients with various ages and aneurysm sizes was also computed, thereby providing a useful index to help patients in the medical decision-making process.

The computer model produced a sample of unruptured aneurysms in the general population with a prevalence of 4.2% and a median diameter of 5.8 mm. These unruptured aneurysms—affected by the rupture rate reported in the ISUIA—had a yearly SAH incidence of 19.6 per 100,000 persons. The median diameter of these aneurysms was 9.4 mm.

Conclusions

Findings in the present study validated the results of the ISUIA by showing that the seemingly low rupture rates could explain the statistical data for ruptured aneurysms. With the featured model, the author calculated the lifetime probability of lesion rupture—a useful measure for deciding on the optimal treatment for unruptured aneurysms.
A mathematical model of the natural history of intracranial aneurysms: quantification of the benefit of prophylactic treatment
Authors: Yoshimoto Yuhei
Published: January 2008

Object

The International Study of Unruptured Intracranial Aneurysms (ISUIA) data raised new controversy regarding the threshold size that requires treatment. In particular, this study has been criticized for disagreeing with previous epidemiological data.

Methods

The author first used a Markov model to simulate the natural history of intracranial aneurysms, making three key assumptions based on prospective ISUIA data and other recent reports: that the rate of de novo aneurysm formation is constant after the age of 20 years; that unruptured aneurysms gain volume at a constant rate; and that unruptured aneurysms rupture at a volume-dependent rate. Next, he expressed outcomes for patients with unruptured aneurysms in terms of expected number of quality-adjusted life years (QALY) and compared two hypothetical cohorts, one receiving treatment and the other not being treated. These assumptions enabled the construction of a mathematical model with epidemiologically compatible findings. The benefits of treatment for unruptured aneurysms were highly influenced by aneurysm size and were calculated as −0.28, 0.25, and 1.07 QALY for patients having unruptured aneurysms with diameters of 7, 10, and 13 mm, respectively.

Conclusions

Under the author’s assumptions, the prospective ISUIA data may be consistent with epidemiological findings. Prophylactic treatment for unruptured aneurysms may produce some benefits in large aneurysms if acceptable treatment risks can be assured, but it is not likely to offer improvement over the natural history for patients with small aneurysms.
Long-term functional results of selective peripheral neurotomy for the treatment of spastic upper limb: prospective study in 31 patients
Authors: Maarrawi Joseph , Mertens Patrick , Luaute Jacques , Vial Christophe , Chardonnet Nicole , Cosson Maryse , Sindou Marc
Published: January 2008

Object

To manage refractory upper-limb spasticity, selective peripheral neurotomy (SPN) is proposed when the spastic muscles to be treated are under the control of a single or a few peripheral nerves. The aim of this study was to assess prospectively the long-term effects of SPN.

Methods

Thirty-one patients with disabling upper-limb spasticity were selected by a multidisciplinary team using clinical, analytical, and functional scales as well as nerve block tests for assessment. Sixty-four SPNs were performed at the level of the musculocutaneous (15 SPNs), the median (25 SPNs), and the ulnar (24 SPNs) nerves. Results of a long term follow up (mean 4.5 years) showed statistically significant improvement on 1) analytical assessment (p < 0.01): resting position, active amplitude, and motor strength; 2) Ashworth Scale scoring (p < 0.01); 3) hand function assessment (p < 0.01); and 4) rating of daily activities. Four patients with severe painful spasticity experienced complete pain relief after surgery. On the basis of a Visual Analog Scale ranging from 0 to 100, the mean degree of patient satisfaction was 61.5. Complications occurred in five patients (15%): two postoperative hematomas, one (temporary) hypesthesia, and one transient paresia of the wrist and finger flexors.

Conclusions

Selective peripheral neurotomy leads to long-term satisfactory improvement in function and/or comfort with a low morbidity rate in appropriately selected patients suffering from severe harmful spasticity of the upper limb that has been refractory to conservative therapy. Patients must be selected after complete assessment by a multidisciplinary team.
Frameless image-guided stereotactic brain biopsy procedure: diagnostic yield, surgical morbidity, and comparison with the frame-based technique
Authors: Woodworth Graeme F. , McGirt Matthew J. , Samdani Amer , Garonzik Ira , Olivi Alessandro , Weingart Jon D.
Published: January 2008

Object

The gold standard for stereotactic brain biopsy target localization has been frame-based stereotaxy. Recently, frameless stereotactic techniques have become increasingly utilized. Few authors have evaluated this procedure, analyzed preoperative predictors of diagnostic yield, or explored the differences in diagnostic yield and morbidity rate between the frameless and frame-based techniques.

Methods

A consecutive series of 110 frameless and 160 frame-based image-guided stereotactic biopsy procedures was reviewed. Associated variables for both techniques were reviewed and compared. All stereotactic biopsy procedures were included in a risk factor analysis of nondiagnostic biopsy sampling.

Frameless stereotaxy led to a diagnostic yield of 89%, with a total permanent morbidity rate of 6% and a mortality rate of 1%. Larger lesions were fivefold more likely to yield diagnostic tissues. Deep-seated lesions were 2.7-fold less likely to yield diagnostic tissues compared with cortical lesions. Frameless compared with frame-based stereotactic biopsy procedures showed no significant differences in diagnostic yield or transient or permanent morbidity. For cortical lesions, more than one needle trajectory was required more frequently to obtain diagnostic tissues with frame-based as opposed to frameless stereotaxy, although this factor was not associated with morbidity.

Conclusions

With regard to diagnostic yield and complication rate, the frameless stereotactic biopsy procedure was found to be comparable to or better than the frame-based method. Smaller and deep-seated lesions together were risk factors for a nondiagnostic tissue yield. Frameless stereotaxy may represent a more efficient means of obtaining biopsy specimens of cortical lesions but is otherwise similar to the frame-based technique.
Integrated positron emission tomography and magnetic resonance imaging–guided resection of brain tumors: a report of 103 consecutive procedures
Authors: Pirotte Benoît , Goldman Serge , Dewitte Olivier , Massager Nicolas , Wikler David , Lefranc Florence , Ben Taib Nordeyn Oulad , Rorive Sandrine , David Philippe , Brotchi Jacques , Levivier Marc
Published: January 2008

Object

The aim of this study was to evaluate the integration of positron emission tomography (PET) scanning data into the image-guided resection of brain tumors.

Methods

Positron emission tomography scans obtained using fluorine-18 fluorodeoxyglucose (FDG) and l-[methyl-11C]methionine (MET) were combined with magnetic resonance (MR) images in the navigational planning of 103 resections of brain tumors (63 low-grade gliomas [LGGs] and 40 high-grade gliomas [HGGs]). These procedures were performed in 91 patients (57 males and 34 females) in whom tumor boundaries could not be accurately identified on MR images for navigation-based resection. The level and distribution of PET tracer uptake in the tumor were analyzed to define the lesion contours, which in turn yielded a PET volume. The PET scanning–demonstrated lesion volume was subsequently projected onto MR images and compared with MR imaging data (MR volume) to define a final target volume for navigation-based resection—the tumor contours were displayed in the microscope’s eyepiece. Maximal tumor resection was accomplished in each case, with the intention of removing the entire area of abnormal metabolic activity visualized during surgical planning. Early postoperative MR imaging and PET scanning studies were performed to assess the quality of tumor resection. Both pre- and postoperative analyses of MR and PET images revealed whether integrating PET data into the navigational planning contributed to improved tumor volume definition and tumor resection.

Metabolic information on tumor heterogeneity or extent was useful in planning the surgery. In 83 (80%) of 103 procedures, PET studies contributed to defining a final target volume different from that obtained with MR imaging alone. Furthermore, FDG-PET scanning, which was performed in a majority of HGG cases, showed that PET volume was less extended than the MR volume in 16 of 21 cases and contributed to targeting the resection to the hypermetabolic (anaplastic) area in 11 (69%) of 16 cases. Performed in 59 LGG cases and 23 HGG cases, MET-PET demonstrated that the PET volume did not match the MR volume and improved the tumor volume definition in 52 (88%) of 59 and 18 (78%) of 23, respectively. Total resection of the area of increased PET tracer uptake was achieved in 54 (52%) of 103 procedures.

Conclusions

Imaging guidance with PET scanning provided independent and complementary information that helped to assess tumor extent and plan tumor resection better than with MR imaging guidance alone. The PET scanning guidance could help increase the amount of tumor removed and target image-guided resection to tumor portions that represent the highest evolving potential.
Long-term effects of experimental intracerebral hemorrhage: the role of iron
Authors: Hua Ya , Nakamura Takehiro , Keep Richard F. , Wu Jimin , Schallert Timothy , Hoff Julian T. , Xi Guohua
Published: January 2008

Object

Intracerebral hemorrhage (ICH) causes brain atrophy and neurological deficits. The mechanisms of brain atrophy after ICH are poorly understood, although recent evidence suggests that some ICH-induced brain injury results from the products of hemoglobin degradation, including iron. In this study the authors examine the role of iron in brain atrophy and neurological deficits following ICH.

Methods

Male Sprague–Dawley rats received an infusion of either 100 μl autologous whole blood or saline into the right caudate. Hematoxylin and eosin staining was used for histological examination, and iron levels and ferritin immunoreactivities were also examined. Deferoxamine was used as an iron chelator. Over the duration of the experiment, the rats underwent behavioral testing (forelimb placing, forelimb use asymmetry, and corner turn tests).

Brain atrophy in the caudate with prolonged neurological deficits occurred after ICH. Although partial functional recovery occurred with time, residual neurological deficits were still detectable at 3 months postprocedure. Iron accumulation and ferritin upregulation were present in the ipsilateral caudate. Deferoxamine reduced brain atrophy and improved behavioral outcomes, and it also reduced brain ferritin immunoreactivity.

Conclusions

An ICH results in an accumulation of iron in the brain that is not cleared within 3 months and that contributes to brain tissue loss and neurological deficits posthemorrhage. Iron chelation may be a useful therapy for patients with ICH.
Transient cerebellar mutism caused by bilateral damage to the dentate nuclei after the second posterior fossa surgery
Authors: Kusano Yoshikazu , Tanaka Yuichiro , Takasuna Hiroshi , Wada Naomichi , Tada Tsuyoshi , Kakizawa Yukinari , Hongo Kazuhiro
Published: January 2008

✓The authors report on the case of a 6-year-old boy who underwent resection of a midline cerebellar tumor. The boy was able to speak fluently after the operation. Magnetic resonance (MR) imaging showed that the right dentate nucleus had been partially removed along with the tumor, but that the left dentate nucleus remained with the residual tumor. A second operation was performed to remove the residue, after which the child suffered mutism. Three weeks postsurgery, he could only communicate through gestures. He started speaking 1 week later and regained normal speech 2 months after the operation. Final MR imaging revealed gross-total removal of the tumor and dentate nucleus on the injured left side. The cerebellar mutism was considered to have been caused by bilateral damage to the dentate nuclei and not by unilateral damage.
Treatment of ruptured intracranial aneurysms since the International Subarachnoid Aneurysm Trial: practice utilizing clip ligation and coil embolization as individual or complementary therapies
Authors: Lanzino Giuseppe , Fraser Kenneth , Kanaan Yassine , Wagenbach Anne
Published: January 2008

Object

The aim of this study was to analyze the therapeutic decision-making process and outcome in 100 consecutive patients with aneurysmal subarachnoid hemorrhage (SAH) treated since the completion of the International Subarachnoid Aneurysm Trial (ISAT). All patients were evaluated and treated by a neurosurgeon with subspecialty training in both cerebrovascular and neuroendovascular surgery.

Methods

One hundred consecutive patients with aneurysmal SAH who had been admitted within 1 week posthemorrhage and who had been treated using either surgical clip application or endovascular coil embolization were included in this analysis. All patients underwent a uniform perioperative protocol. All surviving patients were given a questionnaire to assess their modified Rankin Scale score (mRS) and to grade themselves at 6 months and 1 year postintervention. The cohort consisted of 73 women and 27 men with a mean age of 57.27 years (range 27–87 years). Twenty-nine percent of the patients had a World Federation of Neurosurgical Societies (WFNS) Grade IV or V SAH. Forty-seven patients underwent direct surgical clip application, 41 endovascular embolization, and 12 a combination of the two procedures. Good functional outcome—indicated by mRS scores of 0 to 2 after at least 6 months—was achieved in 71% of patients.

Conclusions

Data from the ISAT demonstrated a better functional outcome following endovascular embolization in a selected group of patients with aneurysmal SAH. In routine clinical practice, however, a significant number of patients still benefit from direct surgical clip ligation. Excellent functional results can be realized in a complementary clip ligation and coil occlusion practice in which each patient and aneurysm is evaluated and the two treatment modalities are used individually or, when needed, in combination.
Effectiveness of neuronavigation in resecting solitary intracerebral contrast-enhancing tumors: a randomized controlled trial
Authors: Willems Peter W. A. , Taphoorn Martin J. B. , Burger Huib , van der Sprenkel Jan Willem Berkelbach , Tulleken Cees A. F.
Published: January 2008

Object

The goal of this study was to assess the impact of neuronavigation on the cytoreductive treatment of solitary contrast-enhancing intracerebral tumors and outcomes of this treatment in cases in which neuronavigation was preoperatively judged to be redundant.

Methods

The authors conducted a prospective randomized study in which 45 patients, each harboring a solitary contrast-enhancing intracerebral tumor, were randomized for surgery with or without neuronavigation. Peri- and postoperative parameters under investigation included the following: duration of the procedure; surgeon’s estimate of the usefulness of neuronavigation; quantification of the extent of resection, determined using magnetic resonance imaging; and the postoperative course, as evaluated by neurological examinations, the patient’s quality-of-life self-assessment, application of the Barthel index and the Karnofsky Performance Scale score, and the patient’s time of death.

The mean amount of residual tumor tissue was 28.9% for standard surgery (SS) and 13.8% for surgery involving neuronavigation (SN). The corresponding mean amounts of residual contrast-enhancing tumor tissue were 29.2 and 24.4%, respectively. These differences were not significant. Gross-total removal (GTR) was achieved in five patients who underwent SS and in three who underwent SN. Median survival was significantly shorter in the SN group (5.6 months compared with 9 months, unadjusted hazard ratio = 1.6); however, this difference may be attributable to the coincidental early death of three patients in the SN group. No discernible important effect on the patients’ 3-month postoperative course was identified.

Conclusions

There is no rationale for the routine use of neuronavigation to improve the extent of tumor resection and prognosis in patients harboring a solitary enhancing intracerebral lesion when neuronavigation is not already deemed advantageous because of the size or location of the lesion.
Correlation between the efferent venous drainage of the tumor and peritumoral edema in intracranial meningiomas: superselective angiographic analysis of 25 cases
Authors: Tanaka Michihiro , Imhof Hans G. , Schucknecht Bernhard , Kollias Spyros , Yonekawa Yasuhiro , Valavanis Anton
Published: January 2008

Object

The extent of peritumoral brain edema (PTBE) associated with meningiomas can be highly variable. The authors studied the correlation between the development of efferent venous drainage from the tumor and the degree of PTBE that occurs in intracranial meningiomas.

Methods

Twenty-five patients with 27 intracranial supratentorial meningiomas were investigated to identify the correlation between the efferent venous drainage system of the tumor and peritumoral edema. The overall mean age of the patients was 54 years. Seventeen patients (68%) were female and eight (32%) were male. All patients underwent magnetic resonance imaging and digital subtraction angiography. In each meningioma, superselective angiography of the dominant feeding artery was performed, including the late venous phase to evaluate the development of the tumor’s draining vein. An edema index (EI) was introduced to serve as an objective means by which to judge the extent of PTBE. Eleven meningiomas (41%), in which the mean EI was 0.14 ± 0.10, clearly showed dominant draining veins originating from the tumor itself. In the other 16 meningiomas (59%), superselective angiography demonstrated no efferent venous drainage from the tumor, which could account for this group’s mean EI value of 1.49 ± 1.05 (p < 0.001)

Conclusions

The current results suggest that hypoplasia of the efferent draining vein from the meningioma itself contributes to PTBE formation. The development of an efferent venous system mitigates against the formation of PTBE. Intratumoral venous congestion can be considered the main cause of PTBE in meningiomas.
Motor neuronal and glial apoptosis in the adult facial nucleus after intracranial nerve transection
Authors: Mattsson Per , Delfani Kioumars , Janson Ann Marie , Svensson Mikael
Published: January 2008

Object

Intracranial lesions affecting the facial nerve are usually associated with significant morbidity and poor functional restitution, despite the fact that a peripheral nerve injury normally recovers well. Mechanistic explanations are needed to direct future therapies. Although neonatal motor neurons are known to die as a result of apoptosis after axotomy, this cell death mechanism has not been explicitly demonstrated after peripheral cranial nerve transection in adult mammals.

Methods

The authors induced substantial retrograde neuronal death in the adult rodent by transecting the facial nerve during its intracranial course. Neuronal apoptosis was demonstrated as shrunken facial motor neurons, retrogradely labeled with fluorogold and with nuclei positively labeled by terminal deoxynucleotidyl transferase–mediated deoxyuridine triphosphate nick–end labeling (TUNEL). Glial apoptosis was demonstrated by double labeling with respect to cell type.

On postinjury Days 7 and 14, the intracranial axotomy led to neuronal apoptosis, corresponding to a neuronal loss that was observed quantitatively in cresyl violet–stained tissue sections obtained using a stereological method. In contrast, no neuronal apoptosis was observed after creating a distal lesion of the facial nerve, which causes less neuronal loss. In addition, glial apoptosis was seen in the facial nucleus after both distal and proximal axotomy. Whereas the proximal intracranial axotomy led to TUNEL-positive nuclei in cells showing markers for oligodendrocytes and microglia, only the latter glial cell population was double labeled with TUNEL-positive nuclei after distal lesioning.

Conclusions

These findings may ultimately lead to new therapeutic strategies in patients suffering from facial nerve palsy due to an intracranial lesion.
Comparison between the microscope and endoscope in the direct endonasal extended transsphenoidal approach: anatomical study
Authors: Catapano Domenico , Sloffer Chris A. , Frank Giorgio , Pasquini Ernesto , D’Angelo Vincenzo A. , Lanzino Giuseppe
Published: January 2008

Object

The authors compare the views afforded by the operating microscope and the endoscope in the direct endonasal extended transsphenoidal approach to the sellar, suprasellar, and parasellar regions.

Methods

Five formalin-fixed, silicone-injected adult cadaveric heads were studied. A direct endonasal transsphenoidal approach was performed via the right nostril, pushing aside the nasal septum. The approach was performed with the microscope first, then with the endoscope. For each step (sellar, suprasellar, and clival), the exposure afforded by direct microscopic view was measured and then compared with that obtained using the endoscope. The direct endonasal approach provides a slightly off-midline view. Although the microscope provides an adequate view of the mid-line structures and part of the contralateral parasellar areas, the addition of the endoscope allows for a more panoramic view and permits widening of the approach in all directions.

Conclusions

An adequate exposure of the sellar, suprasellar, and infrasellar/upper clival regions can be achieved via a simple, direct endonasal approach. From a direct endonasal route, there is a preferential visualization of the structures contralateral to the approach. The endoscope affords a more panoramic view that extends the area covered by the operating microscope.
Medical application of an infrared free-electron laser: selective removal of cholesterol ester in carotid artery atheromatous plaques
Authors: Nakajima Yoshikazu , Iwatsuki Koichi , Ishii Katsunori , Suzuki Sachiko , Fujinaka Toshiyuki , Yoshimine Toshiki , Awazu Kunio
Published: January 2008

Object

The purpose of this study was to determine the effectiveness of infrared free-electron laser (FEL) irradiation of cholesterol esters in human carotid artery (CA) atheromas.

Methods

The degradation of cholesterol ester was estimated from changes in the infrared absorption spectra acquired using microscopic transmission Fourier transform infrared spectroscopy. An FEL emitting radiation at 5.75-μm wavelengths and a power density of 15.9 W/cm2 was used to treat intimal slices of extirpated human arterial atherosclerotic plaques.

Peak signals derived from an ester bond of cholesterol ester decreased in height as irradiation time increased and disappeared completely after 180 seconds. No other change was observed in the infrared absorption spectrum after 180 seconds of irradiation, and no histological damage was noted.

Conclusions

The authors concluded that FEL irradiation can remove cholesterol ester selectively from human atheromatous CA plaques. This novel technique differs from previous approaches involving conventional lasers.
Malacoplakia of the cranium and cerebrum in a human immunodeficiency virus–infected man
Authors: Toubes-Klingler Edna , Prabhu Vikram C. , Bernal Kerry , Poage David , Swindells Susan
Published: January 2008

✓Malacoplakia is a rare chronic inflammatory disease associated with infection and immunosuppression, and very few occurrences have been reported in the cerebrum. The authors describe the case of a 41-year-old man with advanced human immunodeficiency virus (HIV) infection who presented with a very aggressive malacoplakia lesion that had extended through the scalp, temporalis muscle, skull bone, and deep through the dura mater into the superior sagittal sinus and adjacent brain. Pathological examination revealed sheets of histiocytes invading these structures, and macrophages containing numerous round bodies known as Michaelis–Guttmann bodies, pathognomic for malacoplakia. Because of the rarity of this phenomenon, appropriate treatment and management of malacoplakia are speculative. A complete resection of the lesion, antibiotic therapy, and treatment of his underlying HIV infection had a salutary effect, with the patient faring well more than 9 months postoperatively.
Primary myxoma of the parafalcine meninges
Authors: Powers Ciaran J. , Pizzi Catherine C. , Cummings Thomas J. , Friedman Allan H.
Published: January 2008

✓ The authors report on an unusual case of a primary intracranial myxoma in a 39-year-old woman. The patient presented with headache and generalized seizure. Magnetic resonance imaging revealed a large right frontal tumor resembling a parasagittal meningioma. A gross-total resection was performed, and histological review confirmed the lesion as a myxoma. Results of additional workup revealed the absence of a primary myxoma elsewhere. This case represents the third published report of a primary intracranial myxoma and the second report of a supratentorial myxoma.
Coexisting intracranial meningeal melanocytoma, dermoid tumor, and Dandy–Walker cyst in a patient with neurocutaneous melanosis
Authors: Kang Seok-Gu , Yoo Do Sung , Cho Kyoung Suok , Kim Dal Soo , Chang Eon Duck , Huh Pil Woo , Kim Moon Chan
Published: January 2008

✓ Neurocutaneous melanosis (NCM) associated with Dandy–Walker malformation is a very rare congenital neurodysplasia with the same origin. Primary intracranial melanocytic and dermoid tumors are also benign congenital lesions that usually arise from the leptomeninges and are formed by the inclusion of cutaneous ectoderm at the time of neural tube closure. The authors describe a patient with coexisting intracranial meningeal melanocytoma, NCM with Dandy–Walker malformation, and intraventricular dermoid tumor.
Efficacy of and morbidity associated with stereoelectroencephalography using computerized tomography– or magnetic resonance imaging–guided electrode implantation
Authors: de Almeida Antonio Nogueira , Olivier André , Quesney Felipe , Dubeau François , Savard Ghislaine , Andermann Frederick
Published: January 2008

Object

The purpose of this paper was to define the general efficacy of and morbidity associated with stereoelectroencephalography using modern methods of imaging and to particularize the risks related to specific lobes of the brain.

Methods

All patients admitted to the Montreal Neurological Institute who had undergone either computerized tomography – or magnetic resonance imaging–guided electrode implantation by one surgeon (A.O.) were reviewed. The procedure was considered efficient if the obtained information was sufficient to make a decision either in support of or against surgery.

Two hundred seventeen patients underwent 224 implantations with 3022 electrodes. Complications related to each lobe were as follows: temporal lobe, two abscesses (0.54%); frontal lobe, one abscess and three hematomas (1.4%); and occipital lobe, one hypointense lesion found 1 week after electrode explantation (2.6%). Significant risk factors associated with hematomas were implantation in the frontal lobe (p < 0.05) and the use of four or more implanted electrodes (p < 0.025).

General complications included the following: 26 patients, psychiatric symptoms during monitoring; one patient, meningitis; four patients, scalp cellulitis; and two patients, hemiparesis during angiography in the early 1980s. One of these latter patients maintained a mild hemiparesis and represents the only case of permanent neurological sequela in the entire series. Data obtained during recordings supported an indication for surgery in 178 patients (79.5%), excluded a surgical option in 37 patients (16.5%), and were unsatisfactory in nine patients (4%). Thus, the overall efficacy as defined previously was 96%.

Conclusions

Stereoelectroencephalography is an efficient procedure with low associated morbidity. Bilateral exploration of the temporal lobes has a morbidity rate of approximately 1%. A higher risk of hematomas occurs with the implantation of four or more electrodes in the frontal lobes.
Microelectrode-guided implantation of deep brain stimulators into the globus pallidus internus for dystonia: techniques, electrode locations, and outcomes
Authors: Starr Philip A. , Turner Robert S. , Rau Geoff , Lindsey Nadja , Heath Susan , Volz Monica , Ostrem Jill L. , Marks William J.
Published: January 2008

Object

Deep brain stimulation (DBS) of the globus pallidus internus (GPI) is a promising new procedure for the treatment of dystonia. The authors describe their technical approach for placing electrodes into the GPI in awake patients with dystonia, including methodology for electrophysiological mapping of the GPI in the dystonic state, clinical outcomes and complications, and the location of electrodes associated with optimal benefit.

Methods

Twenty-three adult and pediatric patients with various forms of dystonia were included in this study. Baseline neurological status and DBS-related improvement in motor function were measured using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS). The implantation of DBS leads was performed using magnetic resonance (MR) imaging–based stereotaxy, single-cell microelectrode recording, and intraoperative test stimulation to determine thresholds for stimulation-induced adverse effects. Electrode locations were measured on computationally reformatted postoperative MR images according to a prospective protocol.

Conclusions

Physiologically guided implantation of DBS electrodes in patients with dystonia was technically feasible in the awake state in most patients, and the morbidity rate was low. Spontaneous discharge rates of GPI neurons in dystonia were similar to those of globus pallidus externus neurons, such that the two nuclei must be distinguished by neuronal discharge patterns rather than rates. Active electrode locations associated with robust improvement (> 70% decrease in BFMDRS score) were located near the intercommissural plane, at a mean distance from the pallidocapsular border of 3.6 mm.
The Physical Performance Test and the evaluation of functional status in patients with cerebral aneurysms
Authors: King Joseph T. , Tsevat Joel , Roberts Mark S.
Published: January 2008

Object

Cerebral aneurysms can adversely affect the functional status of patients who harbor them through rupture, mass effect, or treatment sequela. The authors compared the Physical Performance Test (PPT)—an observer-administered test requiring the completion of seven tasks—with three functional status measures based on patient self-reports: the Glasgow Outcome Scale (GOS), the modified Rankin Scale (mRS), and the modified Barthel Index (mBI).

Methods

Data were collected from 144 patients with aneurysms who had been recruited from a neurosurgery clinic. The patients completed the PPT and were assigned GOS scores, mRS scores, and mBIs based on their responses during a structured interview. The validity of the PPT was assessed by examining the relationship between the results of the PPT and the values assigned to each patient by using the GOS, mRS, and mBI by applying rank-order methods; the reliability of the PTT was assessed using the Cronbach α coefficient.

The mean age of the patients was 52.8 years; 72% were women and 54% had survived a subarachnoid hemorrhage. The mean ± standard deviation PPT score was 24.0 ± 3.7. The PPT generated a broad distribution of scores, whereas GOS and mRS scores and mBIs displayed significant ceiling effects, that is, 75% of the patients were clustered in the highest categories. The PPT scores were validated by their strong association with GOS scores, mRS scores, and mBIs (for all, p < 0.001), and the reliability of the PPT was demonstrated by a Cronbach α value of 0.77.

Conclusions

The PPT provides an objective measure of functional status in patients with cerebral aneurysms. The results suggest that the PPT may differentiate among patients better than the GOS, mRS, or mBI. The PPT is a valid and reliable instrument for measuring functional status in patients with cerebral aneurysms.
Suprascapular intraneural ganglia and glenohumeral joint connections
Authors: Spinner Robert J. , Amrami Kimberly K. , Kliot Michel , Johnston Shawn P. , Casañas Joaquim
Published: January 2008

Object

Unlike the more commonly noted paralabral cysts (extraneural ganglia), which are well known to result in suprascapular nerve compression, only four cases of suprascapular intraneural ganglia have been reported. Because of their rarity, the pathogenesis of suprascapular intraneural ganglia has been poorly understood and a pathoanatomical explanation has not been provided. In view of the growing literature demonstrating strong associations between paralabral cysts and labral (capsular) pathology, joint connections, and joint communications, the authors retrospectively reviewed the magnetic resonance (MR) imaging studies and postoperative results in the two featured patients to test a hypothesis that suprascapular intraneural ganglia would have analogous findings.

Methods

Two patients who presented with suprascapular neuropathy were found to have intraneural ganglia. Connections to the glenohumeral joint could be established in both patients through posterior labrocapsular complex tears. In neither patient was the joint connection identified preoperatively or intraoperatively, and cyst decompression was performed by itself without attention to the labral tear. The suprascapular intraneural ganglia extended from the glenohumeral joint as far proximally as the level of the nerves’ origin from the upper trunk in the supraclavicular fossa. Although both patients experienced symptomatic improvement after surgery, neurological recovery was incomplete. In both cases, postoperative MR images revealed cyst persistence. In addition, previously unrecognized superior labral anteroposterior (SLAP) Type II lesions (tears of the superior labrum extending anteroposterior and involving the biceps anchor at the labrum without actual extension into the tendon) were visualized. In one patient with a persistent cyst, an MR arthrogram was obtained and demonstrated a communication between the joint and the cyst.

Conclusions

The findings in these two patients support the synovial theory for intraneural ganglia. Based on their experience with intraneural ganglia at other sites, the authors believe that suprascapular intraneural ganglia arise from the glenohumeral joint, egress through a superior (posterior) labral tear, and dissect within the epineurium along an articular branch into the main nerve, following the path of least resistance. Furthermore, these two cases of intraneural ganglia with SLAP lesions are directly analogous to the many cases of paralabral cysts associated with these types of labral tears. By better understanding the origin of this unusual type of ganglia and drawing analogies to the more common extraneural cysts, surgical strategies can be formulated to address the underlying pathoanatomy, improve operative outcomes, and prevent recurrences.
A functional neuroimaging investigation of deep brain stimulation in patients with obsessive–compulsive disorder
Authors: Rauch Scott L. , Dougherty Darin D. , Malone Donald , Rezai Ali , Friehs Gerhard , Fischman Alan J. , Alpert Nathaniel M. , Haber Suzanne N. , Stypulkowski Paul H. , Rise Mark T. , Rasmussen Steven A. , Greenberg Benjamin D.
Published: January 2008

Object

Deep brain stimulation (DBS) of the ventral [anterior internal] capsule/ventral striatum (VC/VS) is under investigation as an alternative to anterior capsulotomy for severe obsessive–compulsive disorder (OCD). In neuroimaging studies of patients with OCD, dysfunction in the orbitofrontal and anterior cingulate cortex, striatum, and thalamus has been identified; and modulation of activity in this circuit has been observed following successful nonsurgical treatment. The purpose of the current study was to test hypotheses regarding changes in regional cerebral blood flow (rCBF) during acute DBS at the VC/VS target in patients with OCD who were participating in a clinical DBS trial.

Methods

Six patients enrolled in a DBS trial for OCD underwent positron emission tomography to measure rCBF; the rCBF measured during acute DBS at high frequency was then compared with those measured during DBS at low frequency and off (control) conditions. On the basis of neuroanatomical knowledge about the VC/VS and neuroimaging data on OCD, the authors predicted that acute DBS at this target would result in modulation of activity within the implicated frontal–basal ganglia–thalamic circuit. Data were analyzed using statistical parametric mapping.

In a comparison of acute high-frequency DBS with control conditions, the authors found significant activation of the orbitofrontal cortex, anterior cingulate cortex, striatum, globus pallidus, and thalamus.

Conclusions

Acute DBS at the VC/VS target is associated with activation of the circuitry implicated in OCD. Further studies will be necessary to replicate these findings and to determine the neural effects associated with chronic VC/VS DBS. Moreover, additional data are needed to investigate whether pretreatment imaging profiles can be used to predict a patient’s subsequent clinical response to chronic DBS.
Induction of macrophagic prostaglandin E2 synthesis by glioma cells
Authors: Nakano Yoshiteru , Kuroda Etsushi , Kito Tomohiro , Yokota Akira , Yamashita Uki
Published: January 2008

Object

It has been reported that glioma cells produce prostaglandin (PG)E2, which promotes the growth of tumor cells and possesses immunosuppressive activity, and that cyclooxygenase (COX) inhibitors impede tumor growth and infiltration. Macrophages in tumor-bearing hosts are activated to produce PGE2, which induces an immunosuppressive state. Note, however, that the precise mechanism by which PGE2 induces an immunosuppressive state is still unclear. In this study, the authors investigated the mechanism of PGE2 production in glioma-bearing hosts.

Methods

The human and murine glioma cells that were studied did not produce a significant amount of PGE2. However, the coculture of human peripheral blood mononuclear cells or murine peritoneal macrophages with glioma cells or conditioned glioma medium led to the production of a large amount of PGE2. In contrast, production of tumor necrosis factor and interleukin (IL)-12p70 by macrophages and cytotoxic T lymphocyte induction were suppressed by culturing with conditioned glioma medium; this suppression was abrogated by the addition of the COX inhibitor indomethacin. The macrophagic expression of COX-2, and particularly the expression of microsomal PGE synthase (mPGES)–1, a terminal enzyme of the arachidonate cascade, was enhanced by the glioma-derived soluble factors. Furthermore, IL-12p70 production was not clearly suppressed in macrophages from mPGES-1–deficient mice. The glioma-derived soluble factors were sensitive to treatment with heat and papain.

Conclusions

These results indicated that PGE2 production by macrophages is enhanced by glioma-derived soluble factors, which induce an immunosuppressive state in glioma-bearing hosts. Therefore, the inhibition of PGE2 synthesis, targeting COX-2 and mPGES-1, is an effective treatment for the induction of antiglioma immune responses.
Dissociated expressive and receptive language functions on magnetoencephalography, functional magnetic resonance imaging, and amobarbital studies
Authors: Kamada Kyousuke , Takeuchi Fumiya , Kuriki Shinya , Todo Tomoki , Morita Akio , Sawamura Yutaka
Published: January 2008

✓Dissociated language functions are largely invalidated by standard techniques such as the amobarbital test and cortical stimulation. Language studies in which magnetoencephalography (MEG) and functional magnetic resonance (fMR) imaging are used to record data while the patient performs lexicosemantic tasks have enabled researchers to perform independent brain mapping for temporal and frontal language functions (MEG is used for temporal and fMR imaging for frontal functions). In this case report, the authors describe a right-handed patient in whom a right-sided insular glioma was diagnosed. The patient had a right-lateralized receptive language area, but expressive language function was identified in the left hemisphere on fMR imaging–and MEG-based mapping. Examinations were performed in 20 right-handed patients with low-grade gliomas (control group) for careful comparison with and interpretation of this patient’s results. In these tests, all patients were asked to generate verbs related to acoustically presented nouns (verb generation) for fMR imaging, and to categorize as abstract or concrete a set of visually presented words consisting of three Japanese letters for fMR imaging and MEG.

The most prominent display of fMR imaging activation by the verb-generation task was observed in the left inferior and middle frontal gyri in all participants, including the patient presented here. Estimated dipoles identified with the abstract/concrete categorization task were concentrated in the superior temporal and supramarginal gyri in the left hemisphere in all control patients. In this patient, however, the right superior temporal region demonstrated significantly stronger activations on MEG and fMR imaging with the abstract/concrete categorization task. Suspected dissociation of the language functions was successfully mapped with these two imaging modalities and was validated by the modified amobarbital test and the postoperative neurological status. The authors describe detailed functional profiles obtained in this patient and review the cases of four previously described patients in whom dissociated language functions were found.
Desmoid-type fibromatoses involving the brachial plexus: treatment options and assessment of c-KIT mutational status
Authors: Seinfeld Joshua , Kleinschmidt-Demasters Bette K. , Tayal Shalini , Lillehei Kevin O.
Published: January 2008

Object

Desmoid-type fibromatoses are a locally invasive soft-tissue lesion that is most commonly encountered in abdominal sites. The tumor also affects head and neck areas, particularly the supraclavicular region, where it may encase and distort the brachial plexus and compromise neurovascular structures. Neurosurgeons may be called on to treat desmoid-type fibromatoses in these sites. The authors describe their experience in treating four patients with desmoid-type fibromatoses involving the brachial plexus and report the results of immunohistochemical analysis of the tumors.

Methods

Gross-total excision with nerve sparing was the first-line therapy of choice, although the surgery was challenging. Intraoperative identification of the site of tumor origin from musculoaponeurotic tissues by the neurosurgeon was necessary in two of the four cases to achieve a correct frozen section or final pathological diagnosis. Immunostaining for c-KIT (CD117) was undertaken in all cases in light of a previous report of positive CD117 immunoreactivity in abdominal desmoid-type fibromatoses.

All four tumors manifested weak focal immunostaining for c-KIT. One of the patients was given adjuvant imatinib mesylate therapy, with limited success. Subsequent polymerase chain reaction testing revealed that three of the four tumors manifested a single base pair change in exon 10 of the c-KIT gene (A to C in two cases and A to G in one case). There was local recurrence in three patients, despite gross-total excision. With the combination of surgery and radiation therapy, local disease control was achieved in three of the four patients.

Conclusions

This represents the first report of c-KIT sequencing in desmoid-type fibromatoses and suggests a possible biological basis for continuing to explore the use of adjuvant imatinib mesylate therapy.
Surgical treatment and outcomes in 15 patients with anterior interosseous nerve entrapments and injuries
Authors: Kim Daniel H. , Murovic Judith A. , Kim Yong-Yeon , Kline David G.
Published: January 2008

Object

The authors present data obtained in 15 surgically treated patients with anterior interosseous nerve (AIN) entrapments and injuries.

Methods

Fifteen patients with AIN entrapments and injuries underwent surgery between 1967 and 1997 at Louisiana State University Health Sciences Center (LSUHSC) or Stanford University Medical Center. Patient charts were reviewed retrospectively. The LSUHSC grading system was used to evaluate the function of muscles supplied by the AIN.

Nontraumatic injuries included seven AIN compressions by bone or soft tissue. Traumatic injury mechanisms consisted of stretch or contusion (six patients), injection (one patient), and burn scar (one patient). Presentations included weakness in the flexor digitorum profundus (FDP) muscle to the index finger, FDP muscle to the middle finger, pronator quadratus muscle, and flexion of the distal phalanx of the thumb. Preoperative evaluations included electromyography and nerve conduction studies as well as elbow and forearm plain radiographs.

On surgery, lesions in continuity involved seven compressions, four stretch or contusion injuries, and one injection injury, all of which demonstrated nerve action potentials (NAPs) and were treated with neurolysis. Among the seven compression and four stretch or contusion injury cases, six and three patients, respectively, had LSUHSC Grade 3 or better functional recoveries postoperatively. Two stretch or contusion injuries involved lesions in continuity but demonstrated negative NAPs at surgery. Thus, each was treated using a graft repair after resection of a neuroma. There was one burn scar injury, which was treated via an end-to-end suture anastomosis, leading to a functional recovery better than Grade 3.

Conclusions

Fifteen AIN entrapments or injuries responded favorably to nerve release and/or repair.