bluuebunny/crossref_metadata_2025 huggingface dataset:
Technical nuances of temporal muscle dissection and reconstruction for the pterional keyhole craniotomy
Authors: McLaughlin Nancy , Cutler Aaron , Martin Neil A.
Published: November 2012

The supraorbital keyhole approach offers a limited access for aneurysms located at the middle cerebral artery (MCA) bifurcation with long M1 segments or proximal M2 aneurysms. Alternative minimally invasive routes centered on the pterion have been developed to address these aneurysms. Appropriate dissection and reconstruction of the temporal muscle are important for optimal exposure and best cosmetic results with the pterional keyhole craniotomy. The authors describe the technical nuances of temporal muscle dissection and reconstruction adapted to the pterional keyhole craniotomy.

After incising the scalp in a curvilinear fashion behind the hairline, an interfascial dissection is performed, allowing anterior reflection of the superficial temporal fat pat and superficial temporal fascia. The temporal muscle is incised 7–10 mm below its insertion at the superior temporal line. The deep temporal fascia and temporal muscle are incised vertically, completing a T-shaped incision. Subperiosteal dissection of both muscle flaps preserves the deep temporal arteries and nerves. A craniotomy measuring 2.5–3 cm in diameter, based anteriorly at the pterion, is made over the sylvian fissure. Dissection of the sylvian fissure and of MCA aneurysms can proceed without the use of retractors. The bone flap and associated hardware is entirely covered by the temporal muscle, which is reconstructed in 2 layers: the temporal muscle/deep temporal fascia and the superficial temporal fascia.

This dissection technique prevents damage to branches of the facial nerve and minimizes temporal muscle damage. Dividing the temporal muscle vertically and reflecting both parts anteriorly and posteriorly prevents suboptimal illumination and visualization under the microscope. Covering the bone flap and related hardware with a multilayer anatomical reconstruction optimizes cosmetic results.
PlGF and sVEGFR-1 in chronic subdural hematoma: implications for hematoma development
Authors: Kalamatianos Theodosis , Stavrinou Lampis C. , Koutsarnakis Christos , Psachoulia Christina , Sakas Damianos E. , Stranjalis George
Published: November 2012

Object

A considerable body of evidence indicates that inflammation and angiogenesis play a significant role in the development and progression of chronic subdural hematoma (CSDH). While various experimental and clinical studies have implicated placental growth factor (PlGF) in the processes that underpin pathological angiogenesis, no study has thus far investigated its expression in CSDH. The actions of PlGF and its related proangiogenic vascular endothelial growth factor (VEGF) are antagonized by a high-affinity soluble receptor, namely soluble VEGF receptor–1 (sVEGFR-1), and thus the ratio between sVEGFR-1 and angiogenic factors provides an index of angiogenic capacity.

Methods

In the present study, using an automated electrochemiluminescence assay, levels of PlGF and sVEGFR-1 were quantified in serum and hematoma fluid obtained in 16 patients with CSDH.

Results

Levels of PlGF and sVEGFR-1 were significantly higher in hematoma fluid than in serum (p < 0.0001). In serum, levels of sVEGFR-1 were higher than those of PlGF (p < 0.0001), whereas in hematoma fluid this difference was not apparent. Furthermore, the ratio of sVEGFR-1 to PlGF was significantly lower in hematoma fluid than in serum (p < 0.0001).

Conclusions

Given previous evidence indicating a role for PlGF in promoting angiogenesis, inflammatory cell chemotaxis, and stimulation, as well as its ability to amplify VEGF-driven signaling under conditions favoring pathological angiogenesis, enhanced expression of PlGF in hematoma fluid suggests the involvement of this factor in the mechanisms of inflammation and angiogenesis in CSDH. Furthermore, a reduced ratio of sVEGFR-1 to PlGF in hematoma fluid is consistent with the proangiogenic capacity of CSDH. Future studies are warranted to clarify the precise role of PlGF and sVEGFR-1 in CSDH.
Radiation-induced imaging changes following Gamma Knife surgery for cerebral arteriovenous malformations
Authors: Yen Chun-Po , Matsumoto Julie A. , Wintermark Max , Schwyzer Lucia , Evans Avery J. , Jensen Mary E. , Shaffrey Mark E. , Sheehan Jason P.
Published: November 2012

Object

The objective of this study was to evaluate the incidence, severity, clinical manifestations, and risk factors of radiation-induced imaging changes (RIICs) following Gamma Knife surgery (GKS) for cerebral arteriovenous malformations (AVMs).

Methods

A total of 1426 GKS procedures performed for AVMs with imaging follow-up available were analyzed. Radiation-induced imaging changes were defined as newly developed increased T2 signal surrounding the treated AVM nidi. A grading system was developed to categorize the severity of RIICs. Grade I RIICs were mild imaging changes imposing no mass effect on the surrounding brain. Grade II RIICs were moderate changes causing effacement of the sulci or compression of the ventricles. Grade III RIICs were severe changes causing midline shift of the brain. Univariate and multivariate logistic regression analyses were applied to test factors potentially affecting the occurrence, severity, and associated symptoms of RIICs.

Results

A total of 482 nidi (33.8%) developed RIICs following GKS, with 281 classified as Grade I, 164 as Grade II, and 37 as Grade III. The median duration from GKS to the development of RIICs was 13 months (range 2–124 months). The imaging changes disappeared completely within 2–128 months (median 22 months) following the development of RIICs. The RIICs were symptomatic in 122 patients, yielding an overall incidence of symptomatic RIICs of 8.6%. Twenty-six patients (1.8%) with RIICs had permanent deficits. A negative history of prior surgery, no prior hemorrhage, large nidus, and a single draining vein were associated with a higher risk of RIICs.

Conclusions

Radiation-induced imaging changes are the most common adverse effects following GKS. Fortunately, few of the RIICs are symptomatic and most of the symptoms are reversible. Patients with a relatively healthy brain and nidi that are large, or with a single draining vein, are more likely to develop RIICs.
Long-term safety and efficacy of stereotactic radiosurgery for vestibular schwannomas: evaluation of 440 patients more than 10 years after treatment with Gamma Knife surgery
Authors: Hasegawa Toshinori , Kida Yoshihisa , Kato Takenori , Iizuka Hiroshi , Kuramitsu Shunichiro , Yamamoto Takashi
Published: November 2012

Object

Little is known about long-term outcomes, including tumor control and adverse radiation effects, in patients harboring vestibular schwannomas (VSs) treated with stereotactic radiosurgery > 10 years previously. The aim of this study was to confirm whether Gamma Knife surgery (GKS) for VSs continues to be safe and effective > 10 years after treatment.

Methods

A total of 440 patients with VS (including neurofibromatosis Type 2) treated with GKS between May 1991 and December 2000 were evaluable. Of these, 347 patients (79%) underwent GKS as an initial treatment and 93 (21%) had undergone prior resection. Three hundred fifty-eight patients (81%) had a solid tumor and 82 (19%) had a cystic tumor. The median tumor volume was 2.8 cm3 and the median marginal dose was 12.8 Gy.

Results

The median follow-up period was 12.5 years. The actuarial 5- and ≥ 10-year progression-free survival was 93% and 92%, respectively. No patient developed treatment failure > 10 years after treatment. According to multivariate analysis, significant factors related to worse progression-free survival included brainstem compression with a deviation of the fourth ventricle (p < 0.0001), marginal dose ≤ 13 Gy (p = 0.01), prior treatment (p = 0.02), and female sex (p = 0.02). Of 287 patients treated at a recent optimum dose of ≤ 13 Gy, 3 (1%) developed facial palsy, including 2 with transient palsy and 1 with persistent palsy after a second GKS, and 3 (1%) developed facial numbness, including 2 with transient and 1 with persistent facial numbness. The actuarial 10-year facial nerve preservation rate was 97% in the high marginal dose group (> 13 Gy) and 100% in the low marginal dose group (≤ 13 Gy). Ten patients (2.3%) developed delayed cyst formation. One patient alone developed malignant transformation, indicating an incidence of 0.3%.

Conclusions

In this study GKS was a safe and effective treatment for the majority of patients followed > 10 years after treatment. Special attention should be paid to cyst formation and malignant transformation as late adverse radiation effects, although they appeared to be rare. However, it is necessary to collect further long-term follow-up data before making conclusions about the long-term safety and efficacy of GKS, especially for young patients with VSs.
Involvement of the right inferior longitudinal fascicle in visual hemiagnosia: a brain stimulation mapping study
Authors: Coello Alejandro Fernández , Duvaux Sophie , De Benedictis Alessandro , Matsuda Ryosuke , Duffau Hugues
Published: November 2012

Neural foundations underlying visual agnosia are poorly understood. The authors present the case of a patient who underwent awake surgery for a right basal temporooccipital low-grade glioma in which direct electrostimulation was used both at the cortical and subcortical level. Brain mapping over the inferior longitudinal fascicle generated contralateral visual hemiagnosia. These original findings are in agreement with recent tractography data that have confirmed the existence of an occipitotemporal pathway connecting occipital visual input to higher-level processing in temporal lobe structures. This is the first report of a true transient visual hemiagnosia elicited through electrostimulation, supporting the crucial role of inferior longitudinal fascicle in visual recognition.
Prevalence and natural history of arachnoid cysts in adults
Authors: Al-Holou Wajd N. , Terman Samuel , Kilburg Craig , Garton Hugh J. L. , Muraszko Karin M. , Maher Cormac O.
Published: November 2012

Object

Arachnoid cysts are a frequent finding on intracranial imaging. The prevalence and natural history of these cysts in adults are not well defined.

Methods

We retrospectively reviewed the electronic medical records of a consecutive series of adults who underwent brain MRI over a 12-year interval to identify those with arachnoid cysts. The MRI studies were reviewed to confirm the diagnosis. For those patients with arachnoid cysts, we evaluated presenting symptoms, cyst size, and cyst location. Patients with more than 6 months' clinical and imaging follow-up were included in a natural history analysis.

Results

A total of 48,417 patients underwent brain MRI over the study period. Arachnoid cysts were identified in 661 patients (1.4%). Men had a higher prevalence than women (p < 0.0001). Multiple arachnoid cysts occurred in 30 patients. The most common locations were middle fossa (34%), retrocerebellar (33%), and convexity (14%). Middle fossa cysts were predominantly left-sided (70%, p < 0.001). Thirty-five patients were considered symptomatic and 24 underwent surgical treatment. Sellar and suprasellar cysts were more likely to be considered symptomatic (p < 0.0001). Middle fossa cysts were less likely to be considered symptomatic (p = 0.01. The criteria for natural history analysis were met in 203 patients with a total of 213 cysts. After a mean follow-up of 3.8 ± 2.8 years (for this subgroup), 5 cysts (2.3%) increased in size and 2 cysts decreased in size (0.9%). Only 2 patients developed new or worsening symptoms over the follow-up period.

Conclusions

Arachnoid cysts are a common incidental finding on intracranial imaging in all age groups. Although arachnoid cysts are symptomatic in a small number of patients, they are associated with a benign natural history for those presenting without symptoms.
Neuroprotective effect of preoperatively induced mild hypothermia as determined by biomarkers and histopathological estimation in a rat subdural hematoma decompression model
Authors: Yokobori Shoji , Gajavelli Shyam , Mondello Stefania , Mo-Seaney Jixiang , Bramlett Helen M. , Dietrich W. Dalton , Bullock M. Ross
Published: November 2012

Object

In patients who have sustained a traumatic brain injury (TBI), hypothermia therapy has not shown efficacy in multicenter clinical trials. Armed with the post hoc data from the latest clinical trial (National Acute Brain Injury Study: Hypothermia II), the authors hypothesized that hypothermia may be beneficial in an acute subdural hematoma (SDH) rat model by blunting the effects of ischemia/reperfusion injury. The major aim of this study was to test the efficacy of temperature management in reducing brain damage after acute SDH.

Methods

The rats were induced with acute SDH and placed into 1 of 4 groups: 1) normothermia group (37°C); 2) early hypothermia group, head and body temperature reduced to 33°C 30 minutes prior to craniotomy; 3) late hypothermia group, temperature lowered to 33°C 30 minutes after decompression; and 4) sham group, no acute SDH (only craniotomy with normothermia). To assess for neuronal and glial cell damage, the authors analyzed microdialysate concentrations of GFAP and ubiquitin carboxyl-terminal hydrolase-L1 (UCH-L1) by using a 100-kD probe. Fluoro-Jade B–positive neurons and injury volume with 2,3,5-triphenyltetrazolium chloride staining were also measured.

Results

In the early phase of reperfusion (30 minutes, 2.5 hours after decompression), extracellular UCH-L1 in the early hypothermia group was significantly lower than in the normothermia group (early, 4.9 ± 1.0 ng/dl; late, 35.2 ± 12.1 ng/dl; normothermia, 50.20 ± 28.3 ng/dl; sham, 3.1 ± 1.3 ng/dl; early vs normothermia, p < 0.01; sham vs normothermia, p < 0.01, analyzed using ANOVA followed by a post hoc Bonferroni test). In the late phase of reperfusion (> 2.5 hours after decompression), extracellular GFAP in the early hypothermia group was also lower than in the normothermia and late hypothermia groups (early, 5.5 ± 2.9 ng/dl; late, 7.4 ± 3.4 ng/dl; normothermia, 15.3 ± 8.4 ng/dl; sham, 3.3 ± 1.0 ng/dl; normothermia vs sham; p < 0.01). The number of Fluoro-Jade B–positive cells in the early hypothermia group was significantly smaller than that in the normothermia group (normothermia vs early: 774,588 ± 162,173 vs 180,903 ± 42,212, p < 0.05). Also, the injury area and volume were smaller in the early hypothermia group in which hypothermia was induced before craniotomy and cerebral reperfusion (early, 115.2 ± 15.4 mm3; late, 344.7 ± 29.1 mm3; normothermia, 311.2 ± 79.2 mm3; p < 0.05).

Conclusions

The data suggest that early, preoperatively induced hypothermia could mediate the reduction of neuronal and glial damage in the reperfusion phase of ischemia/reperfusion brain injury.
Hemorrhagic colloid cyst with intraventricular extension
Authors: Tamura Yoji , Uesugi Teppei , Tucker Adam , Ukita Tohru , Tsuji Masao , Miyake Hiroji , Kuroiwa Toshihiko
Published: November 2012

Colloid cysts of the third ventricle presenting with acute obstructive hydrocephalus due to intracystic and intraventricular hemorrhage are extremely rare. The authors report a case of a 43-year-old man with a hemorrhagic colloid cyst that was treated using endoscopic surgery. A small colloid cyst of the third ventricle was initially diagnosed in the patient, and he was treated conservatively at that time. On admission to the authors' institution he presented with sudden headache onset without neurological deficits. Computed tomography and MRI demonstrated a round hemorrhagic mass lesion in the third ventricle with bilateral intraventricular hemorrhage. Endoscopic resection was performed using a flexible videoscope. Only partial removal of the cyst was performed because of a tough cyst wall with highly viscous, hemorrhagic cystic contents. Histological examination revealed a typical colloid cyst wall and hemorrhage mixed within a mucinous substance. Postoperative serial neuroimaging demonstrated a gradual reduction in the residual cyst size and normalization in the lateral ventricle size.
In vitro experiment for verification of the tandem shunt valve system: a novel method for treating hydrocephalus by flexibly controlling cerebrospinal fluid flow and intracranial pressure
Authors: Aihara Yasuo , Shoji Ichiro , Okada Yoshikazu
Published: November 2012

Object

The CSF shunt valve is a medical device whose main function is to regulate intracranial pressure and drain excess CSF. The authors have developed a new therapeutic method for treating hydrocephalus, namely the tandem shunt valve system, which has the potential of flexibly controlling the CSF flow rate and intracranial pressure in patients.

Methods

The properties of the tandem system were verified by performing in vitro experiments. An in vitro system with a manometer was built to measure pressure and flow rates of water in open systems using the Codman Hakim Programmable Valve and the Strata adjustable pressure programmable valve. A single valve and 2 single shunt valves connected in series (the tandem shunt valve system) were connected to the manometer to check the final pressure.

Results

Conventional single shunt valve systems require valve pressures to be set higher to slow down the CSF flow rate, which inevitably results in a higher final pressure. On the other hand, the tandem shunt valve system uses the combination of 2 valves to slow the CSF flow rate without increasing the final pressure.

Conclusions

The authors succeeded in experimentally demonstrating in vitro results of tandem systems and their effectiveness by applying a model to show that the valve with the higher pressure setting determined the final pressure of the entire system and the flow rate became slower than single shunt valve systems.
Coexistence of dermal sinus tract, dermoid cyst, and encephalocele in a patient presenting with nasal cellulitis
Authors: Karandikar Mahesh , Yellon Robert F. , Murdoch Geoffrey , Greene Stephanie
Published: November 2012

Dermoid cysts, encephaloceles, and dermal sinus tracts represent abnormalities that develop during the process of embryogenesis. The elucidation of the precise timing of formation for these malformations has remained elusive at the molecular level of study. Yet, clinical experience has demonstrated that these malformations do not all occur in the same patient, suggesting a shared pathway that goes awry at distinct points for different patients, resulting in 1 of the 3 malformations. Herein the authors describe a case in which all 3 malformations were present in a single patient. This is the first description in the English literature of a sincipital encephalocele occurring with a dermoid cyst and a dermal sinus tract.
Ventral spinal cerebrospinal fluid leak as the cause of persistent post–dural puncture headache in children
Authors: Schievink Wouter I. , Maya M. Marcel
Published: November 2012

Headache occurs after dural puncture in about 1%–25% of children who undergo the procedure—a rate similar to that seen in adults. Persistence of post–dural puncture headache in spite of bed rest, increased fluid intake, and epidural blood patch treatment, however, is rare. The authors reviewed the medical records and imaging studies of all patients 19 years of age or younger who they evaluated between 2001 and 2010 for intracranial hypotension, and they identified 8 children who had persistent post–dural puncture headache despite maximal medical treatment and placement of epidural blood patches. A CSF leak could be demonstrated radiologically and treated surgically in 3 of these patients, and the authors report these 3 cases.

The patients were 2 girls (ages 14 and 16 years) who had undergone lumbar puncture for evaluation of headache and fever and 1 boy (age 13 years) who had undergone placement of a lumboperitoneal shunt using a Tuohy needle for treatment of pseudotumor cerebri. The boy also had undergone a laminectomy and exploration of the posterior dural sac, but no CSF leak could be identified. All 3 patients presented with new-onset orthostatic headaches, and in all 3 cases MRI demonstrated a large ventral lumbar or thoracolumbar CSF collection. Conventional myelography or digital subtraction myelography revealed a ventral dural defect at L2–3 requiring surgical repair. Through a posterior transdural approach, the dural defect was repaired using 6-0 Prolene sutures and a dural substitute. Postoperative recovery was uneventful, with complete resolution of orthostatic headache and of the ventral cerebrospinal fluid leak on MRI.

The authors conclude that persistent postdural puncture headache requiring surgical repair is rare in children. They note that the CSF leak may be located ventrally and may require conventional or digital subtraction myelography for exact localization and that transdural repair is safe and effective in eliminating the headaches.
Minimally invasive treatment of multilevel spinal epidural abscess
Authors: Safavi-Abbasi Sam , Maurer Adrian J. , Rabb Craig H.
Published: November 2012

The use of minimally invasive tubular retractor microsurgery for treatment of multilevel spinal epidural abscess is described. This technique was used in 3 cases, and excellent results were achieved. The authors conclude that multilevel spinal epidural abscesses can be safely and effectively managed using microsurgery via a minimally invasive tubular retractor system.
Quantitative verification of the keyhole concept: a comparison of area of exposure in the parasellar region via supraorbital keyhole, frontotemporal pterional, and supraorbital approaches
Authors: Cheng Cheng-Mao , Noguchi Akio , Dogan Aclan , Anderson Gregory J. , Hsu Frank P. K. , McMenomey Sean O. , Delashaw Johnny B.
Published: November 2012

Object

This study was designed to determine if the “keyhole concept,” proposed by Perneczky's group, can be verified quantitatively.

Methods

Fourteen (3 bilateral and 8 unilateral) sides of embalmed latex-injected cadaveric heads were dissected via 3 sequential craniotomy approaches: supraorbital keyhole, frontotemporal pterional, and supraorbital. Three-dimensional cartesian coordinates were recorded using a stereotactic localizer. The orthocenter of the ipsilateral anterior clinoid process, the posterior clinoid process, and the contralateral anterior clinoid process are expressed as a center point (the apex). Seven vectors project from the apex to their corresponding target points in a radiating manner on the parasellar skull base. Each 2 neighboring vectors border what could be considered a triangle, and the total area of the 7 triangles sharing the same apex was geometrically expressed as the area of exposure in the parasellar region.

Results

Values are expressed as the mean ± SD (mm2). The total area of exposure was as follows: supraorbital keyhole 1733.1 ± 336.0, pterional 1699.3 ± 361.9, and supraorbital 1691.4 ± 342.4. The area of exposure on the contralateral side was as follows: supraorbital keyhole 602.2 ± 194.7, pterional 595.2 ± 228.0, and supraorbital 553.3 ± 227.2. The supraorbital keyhole skull flap was 2.0 cm2, and the skull flap size ratio was 1:5:6.5 (supraorbital keyhole/pterional/supraorbital).

Conclusions

The area of exposure of the parasellar region through the smaller supraorbital keyhole approach is as adequate as the larger pterional and supraorbital approaches. The keyhole concept can be verified quantitatively as follows: 1) a wide area of exposure on the skull base can be obtained through a small keyhole skull opening, and 2) the side opposite the opening can also be visualized.
Study of fetal and postnatal morphological development of the brain sulci
Authors: Nishikuni Koshiro , Ribas Guilherme Carvalhal
Published: November 2012

Object

The surface of the developing fetal brain undergoes significant morphological changes during fetal growth. The purpose of this study was to evaluate the morphological development of the brain sulci from the fetal to the early postnatal period.

Methods

Two hundred fourteen brain hemispheres from 107 human brain specimens were examined to evaluate the timing of sulcal formation, from its appearance to its complete development. These brains were obtained from cadavers ranging in age from 12 weeks of gestation to 8 months of postnatal life.

Results

The order of appearance of the cerebral sulci, and the number and percentages of specimens found in this study were as follows: longitudinal cerebral fissure at 12 weeks (10/10, 100%); callosal sulcus at 12 weeks (10/10, 100%); hippocampal sulcus at 15 weeks (7/10, 70%); lateral sulcus at 17 weeks (20/22, 90.9%); circular insular sulcus at 17 weeks (18/22, 81.8%); olfactory sulcus at 17 weeks (18/22, 81.8%); calcarine sulcus at 17 weeks (14/22, 63.6%); parietooccipital sulcus at 17 weeks (11/22, 50%); cingulate sulcus at 19 weeks (16/20, 80%); central sulcus at 21 weeks (22/38, 57.9%); orbital sulcus at 22 weeks (9/16, 56.2%); lunate sulcus at 24 ± 2 weeks (12/16, 75%); collateral sulcus at 24 ± 2 weeks (8/16, 50%); superior frontal sulcus at 25 ± 2 weeks (5/6, 83.3%); rhinal sulcus at 25 ± 2 weeks (3/6, 50%); precentral sulcus at 26 ± 3 weeks (2/4, 50%); postcentral sulcus at 26 ± 3 weeks (2/4, 50%); superior temporal sulcus at 26 ± 3 weeks (2/4, 50%); central insular sulcus at 29 ± 2 weeks (4/4, 100%); intraparietal sulcus at 29 ± 2 weeks (2/4, 50%); paraolfactory sulcus at 29 ± 2 weeks (2/4, 50%); inferior frontal sulcus at 30 ± 3 weeks (2/4, 50%); transverse occipital sulcus at 30 ± 3 weeks (2/4, 50%); occipitotemporal sulcus at 30 ± 3 weeks (2/4, 50%); marginal branch of the cingulate sulcus at 30 ± 3 weeks (2/4, 50%); paracentral sulcus at 30 ± 3 weeks (2/4, 50%); subparietal sulcus at 30 ± 3 weeks (2/4, 50%); inferior temporal sulcus at 31 ± 3 weeks (3/6, 50%); transverse temporal sulcus at 33 ± 3 weeks (6/8, 75%); and secondary sulcus at 38 ± 3 weeks (2/4, 50%).

Conclusions

The brain is subjected to considerable morphological changes throughout gestation. During fetal brain development the cortex begins to fold in, thereby increasing the cortical surface. All primary sulci are formed during fetal life. The appearance of each sulcus follows a characteristic timing pattern, which may be used as one of the reliable guides pertinent to gestational age and normal fetal development.
Long-term change in ventricular size following endoscopic third ventriculostomy for hydrocephalus due to tectal plate gliomas
Authors: Romeo Andrew , Naftel Robert P. , Griessenauer Christoph J. , Reed Gavin T. , Martin Richard , Shannon Chevis N. , Grabb Paul A. , Tubbs R. Shane , Wellons John C.
Published: November 2012

Object

Endoscopic third ventriculostomy (ETV) is an alternative to shunt placement in children with hydrocephalus due to tectal plate gliomas (TPGs). However, controversy remains regarding the amount of ventricular size reduction that should be expected after ETV. This study investigates ventricular size change after ETV for TPGs.

Methods

Twenty-two children were identified from a 15-year retrospective database of neuroendoscopic procedures performed at the authors' institution, Children's Hospital of Alabama, in patients with a minimum of 1 year of follow-up. Clinical outcomes, including the need for further CSF diversion and symptom resolution, were recorded. The frontal and occipital horn ratio (FOR) was measured on pre- and postoperative, 1-year, and last follow-up imaging studies.

Results

In 17 (77%) of 22 children no additional procedure for CSF diversion was required. Of those in whom CSF diversion failed, 4 underwent successful repeat ETV and 1 required shunt replacement. Therefore, in 21 (96%) of 22 patients, CSF diversion was accomplished with ETV. Preoperative and postoperative imaging was available for 18 (82%) of 22 patients. The FOR decreased in 89% of children who underwent ETV. The FOR progressively decreased 1.7%, 11.2%, and 12.7% on the initial postoperative, 1-year, and last follow-up images, respectively. The mean radiological follow-up duration for 18 patients was 5.4 years. When ETV failed, the FOR increased at the time of failure in all patients. Failure occurred 1.6 years after initial ETV on average. The mean clinical follow-up period for all 22 patients was 5.3 years. In all cases clinical improvement was demonstrated at the last follow-up.

Conclusions

Endoscopic third ventriculostomy successfully treated hydrocephalus in the extended follow-up period of patients with TPGs. The most significant reduction in ventricular size was observed at the the 1-year followup, with only modest reduction thereafter.
Prospective randomized study of cervical arthroplasty and anterior cervical discectomy and fusion with long-term follow-up: results in 74 patients from a single site
Authors: Coric Domagoj , Kim Paul K. , Clemente Jonathan D. , Boltes Margaret O. , Nussbaum Marcy , James Sara
Published: November 2012

Object

The purpose of this study was to evaluate the long-term results of cervical total disc replacement (TDR) and anterior cervical discectomy and fusion (ACDF) in the treatment of single-level cervical radiculopathy.

Methods

The results of 2 separate prospective, randomized, US FDA Investigational Device Exemption pivotal trials (Bryan Disc and Kineflex|C) from a single investigational site were combined to evaluate outcomes at long-term follow-up. The primary clinical outcome measures included the Neck Disability Index (NDI), visual analog scale (VAS), and neurological examination. Patients were randomized to receive cervical TDR in 2 separate prospective, randomized studies using the Bryan Disc or Kineflex|C cervical artificial disc compared with ACDF using structural allograft and an anterior plate. Patients were evaluated preoperatively; at 6 weeks; at 3, 6, and 12 months; and then yearly for a minimum of 48 months. Plain radiographs were obtained at each study visit.

Results

A total of 74 patients were enrolled and randomly assigned to either the cervical TDR (n = 41) or ACDF (n = 33) group. A total of 63 patients (86%) completed a minimum of 4 years follow-up. Average follow-up was 6 years (72 months) with a range from 48 to 108 months. In both the cervical TDR and ACDF groups, mean NDI scores improved significantly by 6 weeks after surgery and remained significantly improved throughout the minimum 48-month follow-up (p < 0.001). Similarly, the median VAS pain scores improved significantly by 6 weeks and remained significantly improved throughout the minimum 48-month follow-up (p < 0.001). There were no significant differences between groups in mean NDI or median VAS scores. The range of motion (ROM) in the cervical TDR group remained significantly greater than the preoperative mean, whereas the ROM in the ACDF group was significantly reduced from the preoperative mean. There was significantly greater ROM in the cervical TDR group compared with the ACDF group. There were 3 reoperations (7.3%) at index or adjacent levels in the cervical TDR group; all were cervical laminoforaminotomies. There were 2 adjacent-level reoperations in the cervical TDR group (4.9%). There was 1 reoperation (3.0%) in the ACDF group at an index or adjacent level (a second ACDF at the adjacent level). There was no statistically significant difference in overall reoperation rate or adjacent-level reoperation rate between groups.

Conclusions

Both cervical TDR and ACDF groups showed excellent clinical outcomes that were maintained over long-term follow-up. Both groups showed low index-level and adjacent-level reoperation rates. Both cervical TDR and ACDF appear to be viable options for the treatment of single-level cervical radiculopathy.
On the myth called 'African Bioethics': further reflections on Segun Gbadegesin's account
Authors: Kazeem Fayemi Ademola , Adeogun Akintunde Folake
Published: November 2012

This paper examines, and further reflects, on Segun Gbadegesins position on the question of African bioethics. In an attempt to situate bioethical discourse within the garb of cultural appropriateness, Gbadegesin gives an African perspective of bioethics by exploring the attitudes of the Yoruba people (an example of an African culture) towards bioethical issues. Through this, he calls for a transcultural bioethics, which will underscore the universality of bioethics without undermining the significance of cultural identities. This paper challenges as a myth?, the assumptions and positions of Gbadegesin in his recent discourse on African bioethics. By raising and adducing reasons to fundamental questions (such as: How authentic is Gbadegesins reportage on the Yoruba attitude to bioethical issues? How plausible is the possibility of a universal/global bioethics that is anchored on the recognition of all cultures in bioethical discourse? Is there a distinctive African bioethics? If yes, what is the nature of such an inquiry? What are the bioethical principles employed in solving bioethical issues in African culture?), this paper defends the position that there is not yet an African bioethics.DOI: http://dx.doi.org/10.3329/bioethics.v3i3.12558 Bangladesh Journal of Bioethics 2012; 3(3):4-11
Breast cancer with pregnancy in cross cultural setting
Authors: Lasker Shamima P
Published: November 2012

DOI: http://dx.doi.org/10.3329/bioethics.v3i3.12561 Bangladesh Journal of Bioethics 2012; 3(3):21-26
BBS News Vol.3(3)
Authors: Lasker Shamima
Published: November 2012

DOI: http://dx.doi.org/10.3329/bioethics.v3i3.12562 Bangladesh Journal of Bioethics 2012; 3(3):27
In vitro maturation of buffalo oocytes and fertilization by cattle spermatozoa
Authors: Khandoker MAMY , Reza MMT , Asad LY , Saha S , Apu AS , Hoque SAM
Published: November 2012

The present research was undertaken to explore the maturation of buffalo oocytes using bovine follicular fluid (BFF) and bovine serum albumin (BSA), as well as subsequent fertilization using cattle spermatozoa. The cumulus oocyte complexes (COCs) were collected by aspiration of slaughterhouse buffalo ovaries. Maturation was performed in TCM 199 supplemented with 10% BFF, 5% BSA or without supplementation (control). The COCs were fertilized in Brackett and Oliphant (BO) medium using capacitated fresh cattle spermatozoa. It was observed that the percentage of COCs reached to M-II stages were 40.78±3.84, 65.74±2.39 and 67.52±0.85; normal fertilization (formation of 2 pronuclei) were 23.28±3.00, 29.30±0.73 and 30.52±1.21 for control, 10% BFF and 5% BSA supplementation, respectively. The supplementation of BFF (10%) and BSA (5%) were given similar results on maturation and increased significantly (p<0.05) than that of the control. It was observed that cattle spermatozoa were fertilized by the buffalo oocytes and the fertilization rate was 23.28% to 30.52% in BFA and BSA supplemented media, respectively. It can be concluded that buffalo oocytes might be fertilized using capacitated cattle spermatozoa and both 10% BFF and 5% BSA could be supplemented in maturation media to enhance the maturation rate as well as fertilization of buffalo oocytes.http://dx.doi.org/10.3329/bjas.v41i1.11969
Comparison of some important dairy traits of crossbred cows at Baghabarighat milk shed area of Bangladesh
Authors: Hossen MS , Hossain SS , Bhuiyan AKFH , Hoque MA , Talukder MAS
Published: November 2012

Data on 3637 cows of seven genetic groups at Baghabarighat milk shed area during the period from 1991 to 2000 were analyzed. The genetic groups were Pabna Milking Cows (PMC), ½Sahiwal×½PMC (SL×PMC), ½Frisian×½PMC (FN×PMC), ½Australian Friesian Sahiwal×½PMC (AFS×PMC), ½Sahiwal×¼Friesian×¼PMC [SL(FN×PMC)], ½Friesian×¼Sahiwal×¼PMC [FN(SL×PMC)] and ½Friesian×¼Jersey×¼PMC [FN(JR×PMC)]. The purpose of this study was to compare the productive (birth weight, lactation length, lactation yield, fat% and SNF%) and reproductive (age at first service, service per conception, postpartum heat period and calving interval) traits of different crossbred cows. The highest birth weight of calves was obtained as 29.78 kg in AFS×PMC, lactation yield as 2225.52 liters in FN(JR×PMC), fat% as 4.48 in SL×PMC and SNF% as 8.10 in FN(SL×JR). The longest lactation length was observed as 305.18 days in AFS×PMC. The shortest age at first service was observed as 26.83 months in FN(PMC×SL), postpartum heat period as 133.23 days in PMC and calving interval as 414.90 days in PMC. The lowest service per conception was found to be 1.22 in PMC cows. The high genetic variability of birth weight, lactation yield, fat and SNF% indicated that there are good opportunities for genetic improvement of these traits through selection. From the results, it is evident that the level of production of different crossbred cows found to be higher but important reproductive traits were significantly better on PMC. Thus it may be concluded that for long term sustainable development and conservation program for PMC should be initiated alongside with that of crossbred in this particular study area.http://dx.doi.org/10.3329/bjas.v41i1.11970
Growth performance of three genotypes of ducks in coastal region of Bangladesh
Authors: Islam MA , Khan MJ , Debi MR , Rahman MM
Published: November 2012

A study was conducted to determine the growth performance and mortality rate of Khaki Campell, Jinding and Deshi genotypes in two coastal locations of Barisal and Bhola districts of Bangladesh. Sixty-day-old ducks of 3 genotypes were randomly allocated to 3 treatments having 4 replications in each. Ducks are reared up to 150 days and at the end of experiment one male Khaki Campbell of highest live weight was selected from each replicate group. The average weekly body weight gain (g/bird) of the Khaki Campbell and Jinding were significantly (p<0.01) higher than those of the Deshi ducks. The average body weight of Khaki Campbell (1480.25g) was slightly higher than that of Jinding (1428.25g) but significantly (p<0.01) higher than that of Deshi (1140.62g) ducks at the end of the experiment. The mortality rate were significantly different (p<0.01) in various genotypes. The highest mortality was found in Deshi (30.20%) compared to Khaki Campbell (19.79%) and Jinding (17.77%). The profit margin was significantly different (p<0.01) in three genotypes. The ducks reared in Barishal performed better (p<0.01) than that from Bhola. It may be suggested from the present findings that both Khaki Campbell and Jinding ducks are performed better than Deshi in the coastal region of Bangladesh.http://dx.doi.org/10.3329/bjas.v41i1.11971
Performance of Red Chittagong cattle in some selected Areas of Chittagong district of Bangladesh
Authors: Hasanuzzaman M , Hossain ME , Islam MM , Begum MR , Chowdhury S , Hossain MZ
Published: November 2012

A survey was conducted to estimate the productive and reproductive performances of RCC in Rawjan, Chandanaish, Potia, Satkania and Anowara upazillas of Chittagong, Bangladesh. The farmers of the study areas holding Red Chittagong Cattle (RCC) were divided into large (>1.50 acre), medium (>1.0-1.5 acre), marginal (>0.5-1.0 acre) and landless (>0-0.5 acre) categories. Existing feeding and rearing practices, productive and reproductive performances of RCC were investigated. It was found that, most of the RCCs (82%) were reared mainly by the marginal farmers. In between May to September, there was a severe shortage of feeds and fodders for RCC. However, despite severe shortage, the farmers were not interested to cultivate fodder. The degree of shortage for feed round the year had significant variation (p<0.01) among the farmers of all categories. Similar to feed shortage, the tendency of growing non-legume crops had marked variation (P<0.01) among the farmers of all categories. Birth weight, weaning weight, daily milk yield, lactation length, calving interval, age at first service, age at first calving and gestation length were 14.5 kg, 64.6 kg, 2.1 liters, 216 days, 14 months, 2.7 years, 42 months and 279.9 days respectively. It could therefore be inferred that, productivity of RCC may be increased by improving feeding systems in the study areas.http://dx.doi.org/10.3329/bjas.v41i1.11973
Effect of feed supplementation on reproduction, lactation and growth performance of Black Bengal goats grazed on native pasture
Authors: Saha NG , Alam MR , Rahman MM
Published: November 2012

Effect of feed supplementation to does grazed on naturally grown grasses during pre-partum on growth, reproduction and lactation performances of does and growth of the kids were investigated. Fifteen two-toothed and non-pregnant does of about one and half year of age constituted the experimental animals which were randomly allocated in the three groups of 5 and offered A) grazing ad libitum + l00g Mashkalai + 100g Wheat bran, B) grazing ad libitum + 50g Mashkalai + 50g Wheat bran and C) grazing ad libitum. The dry matter intake (DMI) between supplemented groups of A and B were almost similar (90 and 89g/kg w0.75/d respectively) and 12% higher than the control group C (80g/ kg w0.75/d). This DMI represent 4.6, 4.5 and 4.1% of live weight for group A, B and C, respectively. Does in treated group A consumed 30 and 62% more CP than group B and control group C, respectively. Similarly, group B consumed about 25% more CP than group C. There was no effect of grazing and supplementation before the pre-partum period on milk yield between treated group (A and B) and control group C (Av. 157 ml and 156 ml/d, respectively), rearing rate and growth of the suckling kids. Present study suggests that provision of grazing and supplementary feeding increases nutrients intake of does but appear to have no influence on milk yield. Higher prolificacy of Black Bengal goat may not bring any benefit unless milk production is increased.http://dx.doi.org/10.3329/bjas.v41i1.11975
Standardising the Lay: Logics of Change in Programs of Disease Self-management
Authors: Juul Nielsen Annegrete , Grøn Lone
Published: November 2012

The health political discourse on self-care is dominated by the view that the selfmanaging patient represents a more democratic and patient-centric perspective, as he or she is believed to renegotiate the terms on which patient participation in health care has hitherto taken place. The self-managing patient is intended as a challenge to traditional medical authority by introducing lay methods of knowing disease. Rather than a meeting between authoritative professionals and vulnerable patients, the self-managing patient seeks to open up new spaces for a meeting between experts. The present paper questions these assumptions through an ethnographic exploration of a patient-led self-management program called the Chronic Disease Self-Management Program. The program is concerned with what its developers call the social and mental aspects of living with a chronic disease and uses trained patients as role models and program leaders. Drawing inspiration from Annemarie Mol’s term ’logic’, we explore the rationale of ’situations of selfmanagement’ and identify what we call a ’logic of change’, which involves very specific ideas on how life with a chronic condition should be dealt with and directs attention towards particular manageable aspects of life with a chronic condition. This logic of change entails, we argue, a clash not between ’medical’ and ’lay’ forms of knowledge but between different logics or perceptions of how transformation can be achieved: through open-ended and ongoing reflection and experimentation in social settings or through standardised trajectories of change. Returning to the literature on lay forms of knowledge and illness perspectives, we question whether programs such as the Chronic Disease Self-Management Program – despite its apparent patient-centric perspective – reproduces classical hierarchical relations between lay and expert knowledge, albeit in new forms.
’I Was a Model Student’: Illness Knowledge Seeking and Self-care Among Finnish Kidney Recipients
Authors: Ådahl Susanne
Published: November 2012

The customer based ideology currently in use in the Finnish welfare state, as elsewhere, has transformed health care. Responsibility for health, that used to be lodged within society, has become the responsibility of the individual. Self-care is part of this growing trend, where there is an inherent assumption that informed patients are more capable of making decisions about their medical regime, which in turn empowers them. Finnish kidney transplant recipients are, through various sources and forms of health information, encouraged to follow the moral imperative of engaging in certain types of health maintaining behaviour that safeguards the transplant kidney. Being informed and sharing illness related information with peers is a manner of showing gratitude towards the state; a way to, in some fashion, reciprocating the valuable gift of a kidney through caring. Taking my lead from Mol’s (2008) notion of care as a practice, as something that is done by all those involved in giving care, I ask how knowledge seeking and sharing on illness can be a form of self-caring. The aim of the article is, thus, to discuss what role illness-related information has in the process of caring for kidney failure. The data consists of in-depth interviews with 18 kidney transplant recipients narrating their illness trajectory, and additional information solicited on a number of central themes, two of which were the access to illness-related information and involvement in peer support activities.
Difficult Questions and Ambivalent Answers on Genetic Testing
Authors: Wiszmeg Andréa , Lundin Susanne , Torkelson Eva , Hagen Niclas , Lundberg Cecilia
Published: November 2012

A qualitative pilot study on the attitudes of some citizens in southern Sweden toward predictive genetic testing – and a quantitative nation wide opinion poll targeting the same issues, was initiated by the Cultural Scientific Research Team of BAGADILICO. The latter is an international biomedical research environment on neurological disease at Lund University. The data of the two studies crystallized through analysis into themes around which the informants’ personal negotiations of opinions and emotions in relation to the topic centred: Concept of Risk,’Relations and Moral Multi-layers, Worry, Agency and Autonomy, Authority, and Rationality versus Emotion. The studies indicate that even groups of people that beforehand are non-engaged in the issue, harbour complex and ambivalent emotions and opinions toward questions like this. A certain kind of situation bound pragmatism that with difficulty could be shown by quantitative methods alone emerges. This confirms our belief that methodological consideration of combining quantitative and qualitative methods is crucial for gaining a more complex representation of attitudes, as well as for problematizing the idea of a unified public open to inquiry.
’Successful Ageing’ in Practice: Reflections on Health, Activity and Normality in Old Age in Sweden
Authors: Alftberg Åsa , Lundin Susanne
Published: November 2012

This article aims to contribute to the critical examination of the notions of health and activity, and to discuss how these cultural and social constructs have impact on elderly people’s lives. An ethnographic perspective gives fruitful inputs to explore how old people deal with the image of old age as one of decay and decline, while they simultaneously relate to the normative idea of so-called successful ageing. The focus is thus on how elderly people create meaning, and how they manage and make use of the contradictory cultural beliefs that are both understood as normality: old age as a passive period of life involving decline and disease, and activity as an individual responsibility in order to stay healthy. The study sample is created with two different methods, qualitative interviews and two different questionnaires, and the majority of the respondents are 65+ years old. The article demonstrates the intersection between old age and a health-promoting active lifestyle. The notion of activity includes moral values, which shape the beliefs and narratives of being old. This forms part of the concept of self-care management, which in old age is also called successful ageing. The idea that activities are health promoting is the framework in which activities are performed, but significance and meaning are rather created from practice.