bluuebunny/crossref_metadata_2025 huggingface dataset:
A prospective single-center analysis of the safety and efficacy of the HydroCoil embolization system for the treatment of intracranial aneurysms
Authors: Deshaies Eric M. , Adamo Matthew A. , Boulos Alan S.
Published: January 2008

Object

The HydroCoil embolization system is a helical platinum coil coated with a polymeric hydrogel that expands when it contacts aqueous solutions to increase filling volumes, improve mesh stability, and possibly elicit a healing response within the aneurysm. In this paper, the authors report the 1-year recurrence and complication rates of 67 aneurysms embolized with the HydroCoil system.

Methods

Sixty-four consecutive patients (67 total aneurysms) with small (≤ 7 mm), large (8–15 mm), very large (16–24 mm), and giant (≥ 25 mm) aneurysms in the anterior and posterior intracranial circulations were treated with HydroCoils between March 2003 and September 2004. All aneurysms were embolized by the senior author (A.S.B) with HydroCoils alone or in combination with bare platinum coils, until either there was no further angiographic contrast filling of the aneurysm or the microcatheter was pushed out of the dome by the coil mass. Balloon assistance was used in three cases and combined Neuroform stent–coil embolization in eight other cases. To evaluate the safety and 1-year efficacy of the HydroCoil system, periprocedural complications were recorded, and angiographic recurrences were categorized using the Raymond–Roy Occlusion Classification (RROC) system.

The 1-year aneurysm recurrence rate independent of size was 15% in patients treated with HydroCoils. Seventy percent of the patients had stable occlusions. The recurrence rate for small aneurysms was 3.7%, and the combined recurrence rate for small and large aneurysms was 6%. Fifteen percent of the aneurysms initially categorized as RROC Type 2 or 3 with stasis of contrast material at the time of initial embolization improved in RROC type, allowing the authors to develop the aneurysm embolization grade to predict recurrence. The neurological complication rate was 14.9%, of which 4.5% represented permanent neurological deficits.

Conclusions

The HydroCoil embolization system is safe and provides excellent 1-year occlusion of small and large aneurysms with initial RROC Type 1, as well as those with RROC Types 2 and 3 with stasis of contrast material at the time of embolization. Very large and giant aneurysms were not as successfully occluded with this system. Treatment of large and giant internal carotid artery aneurysms was more likely to result in cranial nerve palsies and postembolization headaches than treatment in other locations. The aneurysm embolization grade the authors developed using the results of this study accurately predicted 1-year recurrence rates based on the immediate postembolization angiographic characteristics of the treated aneurysm.
Predictors of hematoma enlargement in patients with intracerebral hemorrhage treated with rapid administration of antifibrinolytic agents and strict blood pressure control
Authors: Sorimachi Takatoshi , Fujii Yukihiko , Morita Kenichi , Tanaka Ryuichi
Published: January 2008

Object

Hematoma enlargement is a major cause of poor outcome in patients with intracerebral hemorrhage (ICH). A combination of rapid administration of antifibrinolytics and strict blood pressure (BP) control for prevention of hematoma enlargement has been recently reported. The authors examined the incidence and predictors of hematoma enlargement in patients with ICH who were treated with this therapy.

Methods

Rapid administration of antifibrinolytic agents consisted of intravenous administration of 2 g tranexamic acid over 10 minutes. Systolic BP was strictly maintained below 150 mm Hg using intravenous nicardipine. Immediately after diagnosis of ICH on computed tomography (CT), 188 patients who were admitted within 24 hours of symptom onset were treated with a combination of rapid administration of antifibrinolytic agents and BP control. Hematoma enlargement was determined on the basis of a second CT scan performed the day after admission. Several factors, including those that have been reported to affect hematoma enlargement, were compared between patients with and without hematoma enlargement.

Hematoma enlargement (≥ 20% volume increase) was observed in eight (4.3%) of 188 patients. Previous use of antiplatelet agents was significantly more frequent in patients with hematoma enlargement (p < 0.05). No significant between-group difference was found for any other factors.

Conclusions

Previous use of antiplatelet agents was a predictor of hematoma enlargement in patients with ICH treated with rapid administration of antifibrinolytic agents and BP control.
Neuronal expression of Fas-associated death domain protein and caspase-8 in the perinidal parenchyma of cerebral arteriovenous malformations
Authors: Takagi Yasushi , Kikuta Ken-Ichiro , Nozaki Kazuhiko , Fujimoto Motoaki , Hayashi Junya , Hashimoto Nobuo
Published: January 2008

Object

The expression and localization of phosphorylated Fas-associated death domain protein (pFADD) and cleaved caspase-8 was examined in human cerebral arteriovenous malformations (AVMs). The authors focused on the perinidal parenchyma to clarify the effect of AVMs on perinidal brain tissue.

Methods

Seventeen cerebral AVMs were analyzed using immunohistochemical methods. Specimens were removed from patients during surgical procedures. The characteristics of the areas that stained positively for pFADD or cleaved caspase-8 were also assessed using an image analysis system. Eleven (65%) of the 17 lesions demonstrated anti-pFADD immunoreactivity and 12 (71%) showed anti–cleaved caspase-8 immunoreactivity. The immunoreactive cells in the perinidal parenchyma demonstrated obvious neuronal morphological characteristics.

The characteristics of pFADD-positive and cleaved caspase-8–positive areas were assessed using the image analysis system. The mean distance from the nidus adjacent to either area was not affected by preoperative hemorrhage. The neuronal densities of pFADD-positive and cleaved caspase-8–positive areas were analyzed using the same system. The density of the control area (samples that were pFADD-negative and cleaved caspase-8 negative) was significantly higher when compared with that of pFADD-positive and cleaved caspase-8–positive areas (p < 0.05). The expressions of cleaved caspase-9, cleaved poly(adenosine diphosphate–ribose) polymerase, and apoptotic cells were analyzed using the terminal deoxynucleotidyl transferase–mediated deoxyuridine triphosphate nick-end labeling method.

Conclusions

Neuronal areas that stained positively for pFADD and cleaved caspase-8 existed around the nidus of AVMs. In these areas, the neuronal density was lower than that in the other parenchyma around the AVM. Neuronal loss around the nidus may be the origin of brain dysfunction around AVMs.
Evaluation of extracranial–intracranial bypass using quantitative magnetic resonance angiography
Authors: Amin-Hanjani Sepideh , Shin John H. , Zhao Meide , Du Xinjian , Charbel Fady T.
Published: January 2008

Object

To date, angiography has been the primary modality for assessing graft patency following extracranial–intracranial bypass. The utility of a noninvasive and quantitative method of assessing bypass function postoperatively was evaluated using quantitative magnetic resonance (MR) angiography.

Methods

One hundred one cases of bypass surgery performed over a 5.5-year period at a single institution were reviewed. In 62 cases, both angiographic and quantitative MR angiographic data were available. Intraoperative flow measurements were available in 13 cases in which quantitative MR angiography was performed during the early postoperative period (within 48 hours after surgery).

There was excellent correlation between quantitative MR angiographic flow and angiographic findings over the mean 10 months of imaging follow up. Occluded bypasses were consistently absent on quantitative MR angiograms (four cases). The flow rates were significantly lower in those bypasses that became stenotic or reduced in diameter as demonstrated by follow-up angiography (nine cases) than in those bypasses that remained fully patent (mean ± standard error of the mean, 37 ± 13 ml/minute compared with 105 ± 7 ml/minute, p = 0.001). Flows were appreciably lower in poorly functioning bypasses for both vein and in situ arterial grafts. All angiographically poor bypasses (nine cases) were identifiable by absolute flows of less than 20 ml/minute or a reduction in flow greater than 30% within 3 months. Good correlation was seen between intraoperative flow measurements and early postoperative quantitative MR angiographic flow measurements (13 cases, Pearson correlation coefficient = 0.70, p = 0.02).

Conclusions

Bypass grafts can be assessed in a noninvasive fashion by using quantitative MR angiography. This imaging modality provides not only information regarding patency as shown by conventional angiography, but also a quantitative assessment of bypass function. In this study, a low or rapidly decreasing flow was indicative of a shrunken or stenotic graft. Quantitative MR angiography may provide an alternative to standard angiography for serial follow up of bypass grafts.
Inhibition of angiogenesis induced by cerebral arteriovenous malformations using Gamma Knife irradiation
Authors: Kiliç Kaya , Konya Deniz , Kurtkaya Özlem , Sav Aydin , Pamir M. Necmettin , Kiliç Türker
Published: January 2008

Object

The authors studied the effect of Gamma Knife irradiation on angiogenesis induced by cerebral arteriovenous malformation (AVM) tissues implanted in the corneas of rats.

Methods

Ten AVM specimens obtained from tissue resections performed at Marmara University between 1998 and 2004 were used. A uniform amount of tissue was implanted into the micropocket between the two epithelial layers of the cornea. Gamma Knife irradiation was applied with dose prescriptions of 15 or 30 Gy to one cornea at 100% iso-dose. Dosing was adjusted so that the implanted cornea of one eye received 1.5 Gy when 15 Gy was applied to the other cornea. Similarly, one cornea received 3 Gy when 30 Gy was applied to the other cornea. Angiogenic activity was graded daily by biomicroscopic observations. Forty-eight other rats were used for microvessel counting and vascularendothelial growth factor (VEGF) staining portions of the experiment. Micropieces of the specimens were again used for corneal implantation. Rats from each group were killed on Days 5, 10, 15, and 20, and four corneas from each group were examined.

Gamma Knife irradiation dose dependently decreased AVM-induced neovascularization in the rat cornea as determined by biomicroscopic grading of angiogenesis, microvessel count, and VEGF expression.

Conclusions

The results suggest that Gamma Knife irradiation inhibits angiogenesis induced by AVM tissue in the cornea angiogenesis model. The data are not directly related to understanding how Gamma Knife irradiation occludes existing AVM vasculature, but to understanding why properly treated AVMs do not recur and do not show neovascularization after Gamma Knife irradiation.
Successful “blind-alley” formation with bypass surgery for a partially thrombosed giant basilar artery tip aneurysm refractory to upper basilar artery obliteration
Authors: Takahashi Jun C. , Murao Kenichi , Iihara Koji , Nonaka Yuko , Taki Junya , Nagata Izumi , Miyamoto Susumu
Published: January 2008

✓Partially thrombosed giant aneurysms that are located at the basilar artery (BA) bifurcation and are not amenable to clip application are among the most challenging lesions for neurosurgeons. They compress vital structures such as the brainstem and the thalamus, and the prognosis is extremely poor when they are left untreated. Although obliteration of the upper BA is a promising approach for these aneurysms, some lesions are refractory to this treatment, and effective additional strategies have not been clearly established. The authors report a case treated by placement of clips in the unilateral posterior cerebral artery (PCA) and posterior communicating artery as well as by superficial temporal artery–PCA bypass after unsuccessful upper BA obliteration. Complete thrombosis and dramatic shrinkage of the aneurysm were obtained.
Unilateral deep brain stimulation of the subthalamic nucleus for Parkinson disease
Authors: Slowinski Jerzy L. , Putzke John D. , Uitti Ryan J. , Lucas John A. , Turk Margaret F. , Kall Bruce A. , Wharen Robert E.
Published: January 2008

Object

The object of this study was to assess the results of unilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) for management of advanced Parkinson disease (PD).

Methods

A clinical series of 24 patients (mean age 71 years, range 56–80 years) with medically intractable PD, who were undergoing unilateral magnetic resonance imaging–targeted, electrophysiologically guided STN DBS, completed a battery of qualitative and quantitative outcome measures preoperatively (baseline) and postoperatively, using a modified Core Assessment Program for Intracerebral Transplantations protocol.

The mean follow-up period was 9 months. Statistically significant improvement was observed in the Unified Parkinson's Disease Rating Scale (UPDRS) Part II score (18%), the total UPDRS PART III score (31%), the contralateral UPDRS Part III score (63%), and scores for axial motor features (19%), contralateral tremor (88%), rigidity (60%), bradykinesia (54%), and dyskinesia (69%), as well as the Parkinson's Disease Quality of Life questionnaire score (15%) in the on-stimulation state compared with baseline. Ipsilateral symptoms improved by approximately 15% or less. Performance on the Purdue pegboard test improved in the contralateral hand in the on-stimulation state compared with the off-stimulation state (38%, p < 0.05). The daily levodopa-equivalent dose was reduced by 21% (p = 0.018). Neuropsychological tests revealed an improvement in mental flexibility and a trend toward reduced letter fluency. There were no permanent surgical complications. Of the 16 participants with symmetrical disease, five required implantation of the DBS unit on the second side.

Conclusions

Unilateral STN DBS is an effective and safe treatment for selected patients with advanced PD. Unilateral STN DBS provides improvement of contralateral motor symptoms of PD as well as quality of life, reduces requirements for medication, and possibly enhances mental flexibility. This method of surgical treatment may be associated with a reduced risk and may provide an alternative to bilateral STN DBS for PD, especially in older patients or patients with asymmetry of parkinsonism.
Orthotopic transplantation of v-src–expressing glioma cell lines into immunocompetent mice: establishment of a new transplantable in vivo model for malignant glioma
Authors: Smilowitz Henry M. , Weissenberger Jakob , Weis Joachim , Brown Judith D. , O'Neill Rachel J. , Laissue Jean A.
Published: January 2008

Object

The aim of this study was to develop and characterize a new orthotopic, syngeneic, transplantable mouse brain tumor model by using the cell lines Tu-9648 and Tu-2449, which were previously isolated from tumors that arose spontaneously in glial fibrillary acidic protein (GFAP)-v-src transgenic mice.

Methods

Striatal implantation of a 1-μl suspension of 5000 to 10,000 cells from either clone into syngeneic B6C3F1 mice resulted in tumors that were histologically identified as malignant gliomas. Prior subcutaneous inoculations with irradiated autologous cells inhibited the otherwise robust development of a microscopically infiltrating malignant glioma. Untreated mice with implanted tumor cells were killed 12 days later, when the resultant gliomas were several millimeters in diameter. Immunohistochemically, the gliomas displayed both the astroglial marker GFAP and the oncogenic form of signal transducer and activator of transcription–3 (Stat3). This form is called tyrosine-705 phosphorylated Stat3, and is found in many malignant entities, including human gliomas. Phosphorylated Stat3 was particularly prominent, not only in the nucleus but also in the plasma membrane of peripherally infiltrating glioma cells, reflecting persistent overactivation of the Janus kinase/Stat3 signal transduction pathway. The Tu-2449 cells exhibited three non-random structural chromosomal aberrations, including a deletion of the long arm of chromosome 2 and an apparently balanced translocation between chromosomes 1 and 3. The GFAP-v-src transgene was mapped to the pericentromeric region of chromosome 18.

Conclusions

The high rate of engraftment, the similarity to the high-grade malignant glioma of origin, and the rapid, locally invasive growth of these tumors should make this murine model useful in testing novel therapies for human malignant gliomas.
Nonconvulsive status epilepticus in patients suffering spontaneous subarachnoid hemorrhage
Authors: Little Andrew S. , Kerrigan John F. , McDougall Cameron G. , Zabramski Joseph M. , Albuquerque Felipe C. , Nakaji Peter , Spetzler Robert F.
Published: January 2008

Object

Nonconvulsive status epilepticus (NCSE) is an underrecognized and poorly understood complication of aneurysmal subarachnoid hemorrhage (SAH). The authors evaluated the risk factors, electroencephalographic (EEG) characteristics, hospital course, and clinical outcomes associated with NCSE in a population with SAH treated at a single institution.

Methods

The hospitalization and outcome data were reviewed in 11 patients who had received a diagnosis of NCSE and SAH. The study included individuals from a cohort of 389 consecutive patients with SAH who were treated between March 2003 and June 2005, and who were analyzed retrospectively. The patients' medical history, neurological grade, events of hospitalization, EEG morphological patterns, and disposition were analyzed.

Advanced age, female sex, need for ventriculostomy, poor neurological grade (Hunt and Hess Grade III, IV, or V), thick cisternal blood clots, and structural lesions (intracerebral hemorrhage and stroke) were common in the population with NCSE. Patients with normal results on angiograms, good neurological grade (Hunt and Hess Grade I or II), and minimal SAH (Fisher Grade 1 or 2) were at lower risk. The most common ictal patterns were intermittent, and consisted of generalized periodic epileptiform discharges. Medical complications were also frequent, and the outcome of these patients was poor despite aggressive treatment regimens.

Conclusions

Nonconvulsive status epilepticus is a devastating complication of SAH with a high rate of associated morbidity. Based on these findings it appears that the patients at highest risk for NCSE can be identified, and this should provide a basis for further studies designed to determine the clinical significance of various EEG patterns and to develop preventative strategies.
Endovascular treatment of blood blister–like aneurysms of the internal carotid artery
Authors: Park Jae Hyo , In Sung Park , Han Dae Hee , Kim Seong Hyun , Oh Chang Wan , Kim Jeong-Eun , Kim Hyun Jib , Han Moon Hee , Kwon O-Ki
Published: January 2008

Object

Because of its thin wall, an aneurysm arising from the posterior wall of the internal carotid artery (ICA), the so-called blood blister–like aneurysm (BBA), is difficult to manage surgically and is often associated with high morbidity and mortality rates. The authors treated these aneurysms endovascularly. In this paper, they present angiographic and clinical results obtained in patients with ICA BBAs treated endovascularly.

Methods

In seven patients with ICA BBAs who presented with subarachnoid hemorrhage, a total number of 12 endovascular treatments were performed, including seven endosaccular coil embolizations (four conventional, two stent-assisted and one balloon-assisted procedure) in four patients and five endovascular ICA trapping procedures in five patients. Repeated endovascular treatments were undertaken in four patients. In two patients, the endovascular treatment was performed after failure of surgical treatment (one case of rebleeding after clip placement and one aneurysmal regrowth after wrapping). A balloon occlusion test (BOT) was performed in all patients prior to ICA trapping.

All four patients treated by endosaccular coil embolization showed aneurysmal regrowth. Neither stents nor balloons helpfully prevented aneurysmal regrowth. Of these four patients, two experienced rebleeding. These two patients remained vegetative at the last follow-up examination. After the BOT, ICA trapping was performed with coils and balloons without complication in five patients; excellent outcomes were achieved in all cases but one in which the patient had been in poor neurological condition due to rebleeding after surgical clip therapy.

Conclusions

All ICA BBAs that were treated by endosaccular coil embolization exhibited regrowth of the aneurysm. Some of the lesions rebled. The majority of patients who underwent ICA trapping experienced excellent outcomes. Based on the authors' experiences, they suggest that ICA trapping including the lesion segment should be considered as a first option for definitive treatment if a BOT reveals satisfactory results. Regarding trapping methods, endovascular treatment may be preferred because of its convenience and safety.
Variations in the response of interleukins in neurosurgical intensive care patients monitored using intracerebral microdialysis
Authors: Hillman Jan , Åneman Oscar , Persson Mikael , Andersson Chris , Dabrosin Charlotte , Mellergård Pekka
Published: January 2008

Object

The aim of this study was to make a preliminary evaluation of whether microdialysis monitoring of cytokines and other proteins in severely diseased neurosurgical patients has the potential of adding significant information to optimize care, thus broadening the understanding of the function of these molecules in brain injury.

Methods

Paired intracerebral microdialysis catheters with high-cutoff membranes were inserted in 14 comatose patients who had been treated in a neurosurgical intensive care unit following subarachnoidal hemorrhage or traumatic brain injury. Samples were collected every 6 hours (for up to 7 days) and were analyzed at bedside for routine metabolites and later in the laboratory for interleukin (IL)–1 and IL-6; in two patients, vascular endothelial growth factor and cathepsin-D were also checked.

Aggregated microprobe data gave rough estimations of profound focal cytokine responses related to morphological tissue injury and to anaerobic metabolism that were not evident from the concomitantly collected cerebrospinal fluid data. Data regarding tissue with no macroscopic evidence of injury demonstrated that IL release not only is elicited in severely compromised tissue but also may be a general phenomenon in brains subjected to stress. Macroscopic tissue injury was strongly linked to IL-6 but not IL-1b activation. Furthermore, IL release seems to be stimulated by local ischemia. The basal tissue concentration level of IL-1b was estimated in the range of 10 to 150 pg/ml; for IL-6, the corresponding figure was 1000 to 20,000 pg/ml.

Conclusions

Data in the present study indicate that catheters with high-cutoff membranes have the potential of expanding microdialysis to the study of protein chemistry as a routine bedside method in neurointensive care.
Surgical and endovascular management of symptomatic posterior circulation fusiform aneurysms
Authors: Coert Bert A. , Chang Steven D. , Do Huy M. , Marks Michael P. , Steinberg Gary K.
Published: January 2008

Object

Patients with fusiform aneurysms can present with subarachnoid hemorrhage (SAH), mass effect, ischemia, or unrelated symptoms. The absence of an aneurysm neck impedes the direct application of a clip and endovascular coil deployment. To evaluate the effects of their treatments, the authors retrospectively analyzed a consecutive series of patients with posterior circulation fusiform aneurysms treated at Stanford University Medical Center between 1991 and 2005.

Methods

Forty-nine patients (mean age 53 years, male/female ratio 1.2:1) treated at the authors' medical center form the basis of the analysis. Twenty-nine patients presented with an SAH. The patients presenting without SAH had cranial nerve dysfunction (five patients), symptoms of mass effect (eight patients), ischemia (six patients), or unrelated symptoms (one patient). The aneurysms were located on the vertebral artery (VA) or posterior inferior cerebellar artery (PICA) (21 patients); vertebrobasilar junction (VBJ) or basilar artery (BA) (18 patients); and posterior cerebral artery (PCA) (10 patients). Pretreatment clinical grades were determined using the Hunt and Hess scale; for patients with un-ruptured aneurysms (Hunt and Hess Grade 0) functional subgrades were added. Outcome was evaluated using the Glasgow Outcome Scale (GOS) score during a mean follow-up period of 33 months.

Overall long-term outcome was good (GOS Score 4 or 5) in 59%, poor (GOS Score 2 or 3) in 16%, and fatal (GOS Score 1) in 24% of the patients. In a univariate analysis, poor outcome was predicted by age greater than 55 years, VBJ location, pretreatment Hunt and Hess grade in patients presenting with SAH, and incomplete aneurysm thrombosis after endovascular treatment. In a multivariate analysis, age greater than 55 years was the confounding factor predicting poor outcome. Stratification by aneurysm location removed the effect of age. Of 13 patients with residual aneurysm after treatment, five (38%) subsequently died of SAH (three patients) or progressive mass effect/brainstem ischemia (two patients).

Conclusions

Certain posterior circulation aneurysm locations (PCA, VA–PICA, and BA–VBJ) represent separate disease entities affecting patients at different ages with distinct patterns of presentation, treatment options, and outcomes. Favorable overall long-term outcome can be achieved in 90% of patients with PCA aneurysms, in 60% of those with VA–PICA aneurysms, and in 39% of those with BA–VBJ aneurysms when using endovascular and surgical techniques. The natural history of the disease was poor in patients with incomplete aneurysm thrombosis after treatment.
Cystic vestibular schwannomas: a possible role of matrix metalloproteinase–2 in cyst development and unfavorable surgical outcome
Authors: Moon Kyung-Sub , Jung Shin , Seo Seung-Kwon , Jung Tae-Young , Kim In-Young , Ryu Hyang-Hwa , Jin Yong-Hao , Jin Shu-Guang , Jeong Young-Il , Kim Kyung-Keun , Kang Sam-Suk
Published: January 2008

Object

The authors evaluated the clinical manifestations and surgical results in patients with cystic vestibular schwannoma (VS), and investigated the matrix metalloproteinase (MMP) expression of the cyst fluid and wall in an attempt to elucidate the pathogenesis and characteristics of this disease.

Methods

The clinical and neuroimaging features, perioperative findings, and surgical outcomes in 24 cases of cystic VS and 82 cases of solid VS, all of which were treated using the suboccipital approach, were retrospectively compared. To evaluate the role of MMP in cystic VS, gelatin zymography and immunohistochemical studies of the cyst fluid, wall, and solid portion were performed in nine cases of this disease.

The mean duration of symptoms was shorter (14.0 months compared with 26.1 months; p = 0.04) and the mean size of the tumor was larger (43.8 mm compared with 34.2 mm; p = 0.048) in the cystic than the solid VS group. Although gross-total resection was easier to accomplish in this group (100% compared with 84.1%), adhesion to the facial nerve was more frequent (62.5% compared with 48.8%; p = 0.042). On gelatin zymography studies, MMP-2 expression was ubiquitously observed in all cyst fluids. Immunohistochemical analysis of the cyst wall showed that MMP-2 was apparently localized to the tumor cells on the luminal inner surface, adjacent to the cyst cavity.

Conclusions

Resection of cystic VS is complicated by severe adhesion of the tumor capsule to the facial nerve and the large size of the lesion. The authors believe that MMP-2 may be involved in the pathogenesis of cyst formation or in its enlargement and may aggravate adhesion to the facial nerve, either by promoting the enlargement of the tumor or engendering the degradation of the tumor–nerve barrier proteolytically.
Progressive perianeurysmal edema induced after endovascular coil embolization
Authors: Horie Nobutaka , kitagawa Naoki , Morikawa Minoru , Tsutsumi Keisuke , Kaminogo Makio , Nagata Izumi
Published: January 2008

✓The authors report three cases of progressive vasogenic brain edema surrounding a cerebral aneurysm after endovascular coil embolization. In all three cases embolization was incomplete due to the aneurysms' large sizes and wide necks. Follow-up magnetic resonance imaging revealed de novo vasogenic brain edema surrounding the aneurysms 3 to 6 months after the initial treatment. The edema progressed in parallel with regrowth of the aneurysms. All three aneurysms were deep in the brain parenchyma and showed intramural enhancement, suggesting hemorrhage or inflammation. Each patient underwent a second embolization for the aneurysm regrowth, which resulted in improvement of the edema.

Based on the findings in these cases and review of the literature, it is suggested that incomplete occlusion of larger aneurysms that are deep within the brain may lead to a disorganized intraluminal thrombosis, aneurysm pulsing, and intramural hemorrhage or inflammation, all of which are associated with brain edema following aneurysm recanalization and regrowth. It should be kept in mind that incomplete embolization of larger aneurysms may cause such malignant change and that this complication may occur after endovascular treatment.
Postoperative cranial fasciitis
Authors: Summers Lori E. , Florez Luisa , Berberian John M. , Bhattacharjee Meena , Walsh John W.
Published: January 2008

✓The authors report two cases of cranial fasciitis occurring at prior craniotomy sites. They review the presentation and pathological features associated with cranial fasciitis and describe two unusual cases and their treatment. The first case is that of a 16-year-old girl who underwent suboccipital craniectomy for resection of medulloblastoma and 14 months later was found to have a 4-cm nontender mass at the incision site, with evidence of skull erosion on neuroimaging. Resection of the mass revealed cranial fasciitis. The patient later developed two more lesions in the cranial region, as well as lesions on the chest wall and abdomen consistent with nodular fasciitis; all of the lesions were resected. The second case is that of a 61-year-old man who underwent suboccipital craniectomy for hypertensive hemorrhage and 2 years later was found to have an enlarging mass at the incision site, causing compression of the cerebellum. The mass was resected and found to be consistent with cranial fasciitis.

Cranial fasciitis is a rare, benign lesion of the cranial region. It is histologically identical to nodular fasciitis, a self-limiting fibroblastic process of the superficial and deep fascia. Although most cases of cranial fasciitis are reported to occur spontaneously in the very young, the two cases reported here involved older patients and lesions that developed at prior craniotomy sites in a delayed fashion, a phenomenon not previously reported. Interestingly, one patient exhibited lesions in other areas as well.
Spontaneous intracranial hypotension and immediate improvement following epidural blood patch placement demonstrated by intracranial pressure monitoring
Authors: Zada Gabriel , Pezeshkian Patrick , Giannotta Steven
Published: January 2008

✓ The presentation of spontaneous intracranial hypotension (SIH) can be associated with various clinical and neuro-imaging features that may impede a rapid diagnosis of this entity. The authors report the case of a patient who presented with bilateral third cranial nerve palsies and bilateral subdural hematomas. Intracranial pressure monitoring proved to be useful in the diagnosis and management of SIH in this patient.
Large ophthalmic segment aneurysms with anterior optic pathway compression: assessment of anatomical and visual outcomes after endosaccular coil therapy
Authors: Heran Navraj S. , Song Joon K. , Kupersmith Mark J. , Niimi Yasunari , Namba Katsunari , Langer David J. , Berenstein Alejandro
Published: January 2008

Object

The optimal therapy for ophthalmic segment aneurysms with anterior optic pathway compression (AOPC) is undecided. Surgical results have been described, but the results of endovascular coil therapy have not been well documented.

Methods

The authors retrospectively reviewed data obtained in all patients who harbored unruptured ophthalmic segment aneurysms with AOPC who underwent endovascular coil therapy at their institution. They analyzed baseline and outcome visual function, aneurysm features, extent of aneurysm closure, internal carotid artery (ICA) occlusion, additional interventions, and neurological outcome.

In 17 patients (16 women), age 38 to 83 years, there were 28 affected eyes. All aneurysms were greater than 10 mm in diameter. In the initial procedures 16 of 17 patients received endosaccular coils and the ICA was preserved; in one patient the aneurysm was trapped and the ICA occluded. Patients then underwent follow up for a mean of 2.90 years (range 1 month–11.2 years) after the last procedure. One patient died of subarachnoid hemorrhage (SAH) 1 month postoperatively and thus no follow-up data were available for this case. Vision worsened in six patients, stabilized in four, and improved in six. Twelve patients underwent 13 subsequent procedures, including endovascular ICA occlusion in seven, repeated coil therapy in five, and optic nerve decompression in one; vision improved in 83% of these cases after ICA occlusion. A second patient died of SAH 5 months after repeated coil treatment. At the final follow up, vision had improved in eight patients (50%), stabilized in four (25%), and worsened in four (25%). In 16 patients with follow-up studies, aneurysm closure was complete in eight (50%) and incomplete in eight (50%).

Conclusions

The authors found that in patients with ophthalmic segment aneurysms causing chronic AOPC, endosaccular platinum coil therapy, with ICA preservation, may not benefit vision and that additional procedures may be needed. Evaluation of their results suggests that endovascular trapping of the aneurysm and sacrifice of the ICA appear to result in good visual, clinical, and anatomical outcomes.
Changes in adjacent-level disc pressure and facet joint force after cervical arthroplasty compared with cervical discectomy and fusion
Authors: Chang Ung-Kyu , Kim Daniel H. , Lee Max C. , Willenberg Rafer , Kim Se-Hoon , Lim Jesse
Published: January 2008

Object

The authors of previous in vitro investigations have reported an increase in adjacent-level intradiscal pressures (IDPs) and facet joint stresses following cervical spine fusion. This study was performed to compare adjacent-level IDPs and facet force following arthroplasty with the fusion model.

Methods

Eighteen human cadaveric cervical spines were tested in the intact state for different modes of motion (extension, flexion, bending, and rotation) up to 2 Nm. The specimens were then divided into three groups: those involving the ProDisc-C cervical artificial disc, Prestige cervical artificial disc, and cervical fusion. They were load tested after application of instrumentation or surgery at the C6–7 level. During the test, IDPs and facet forces were measured at adjacent levels.

Results

In arthroplasty-treated specimens, the IDP showed little difference from that of the intact spine at both proximal and distal levels. In fusion-treated specimens, the IDP increased at the posterior anulus fibrosus on extension and at the anterior anulus fibrosus on flexion at the proximal level. At the distal level, the IDP change was not significant. The facet force changes were minimal in flexion, bending, and rotation modes in both arthroplasty- and fusion-treated spines. Significant changes were noted in the extension mode only. In extension, arthroplasty models exhibited significant increases of facet force at the treated level. In the fusion model the facet forces decreased at the treated segment and increased at the adjacent segment.

Conclusions

The two artificial discs of the semiconstrained systems maintain adjacent-level IDPs near the preoperative values in all modes of motion, but with respect to facet force pressure tended to increase after arthroplasty.
Traumatic C6–7 subluxation with anomalous course of vertebral arteries treated with pedicle screw/rod fixation
Authors: Yamazaki Masashi , Koshi Takana , Mannoji Chikato , Okawa Akihiko , Koda Masao
Published: January 2008

✓ The authors report the case of a 62-year-old woman who suffered an accidental fall and complained of severe neck pain and right C-7 radiculopathy. A right C6–7 facet fracture–subluxation was diagnosed. Bone fragments impinged on the right C-7 nerve root at the neural foramen. The bilateral vertebral arteries (VAs) ascended at the anterior aspect of C-6 and C-5 and entered the transverse foramen at the C-4 level.

Based on findings of anomalous VAs, the authors applied a pedicle screw (PS)/rod system to effect surgical correction of the deformity. Intraoperatively, they successfully performed reduction of the subluxation, decompression of the impinged nerve root, and minimum single-segment fusion involving the placement of a PS/rod system. After surgery, the patient's neurological deficit dramatically improved and spinal fusion was completed without any loss of deformity correction.

Prior to surgery for cervical injuries, the possible presence of an abnormal VA course should be considered. Preoperative detection of anomalous VAs will affect decisions on the appropriate corrective surgery option in cases of cervical spine injuries.
Endoscopic resection of a presacral schwannoma
Authors: Yang Chih-Chuan , Chen Hung-Chang , Chen Chien-Min
Published: January 2008

✓Presacral tumors are rarely found in adults. Resections via open abdominal or sacral approaches have been advocated traditionally as the preferred treatment for these tumors. The endoscopic surgical technique provides direct visualization of the presacral or retroperitoneal space. The authors report on a 67-year-old man who experienced difficulty in defecation off and on for 5 weeks, and recently he had suffered indistinct pain in the lower abdomen. The abdominal computed tomography scan revealed a 5.1 × 4.2–cm, homogeneous, low-density, well-defined mass arising from the left sciatic nerve abutting the left piriformis muscle, favoring a diagnosis of benign neurogenic tumor. Endoscopically guided resection was applied, with a favorable outcome. This procedure represents a less invasive approach that may be useful for benign retroperitoneal pelvic tumors.
Factors influencing segmental range of motion after lumbar total disc replacement using the ProDisc II prosthesis
Authors: Kim Dong-Hyun , Ryu Kyeong-Sik , Kim Moon-Kyu , Park Chun-Kun
Published: January 2008

Object.

The purpose of this prospective controlled study was to evaluate possible factors that could affect postoperative segmental range of motion (ROM) after lumbar total disc replacement (TDR) using the ProDisc II prosthesis.

Methods.

Thirty-two consecutive patients with intractable discogenic pain underwent lumbar TDR using the Pro-Disc II prosthesis, 30 of whom were followed up for at least 24 months. Segmental ROM was assessed preoperatively and every 6 months postoperatively using dynamic x-ray films. Segmental ROM at the reference level was assessed in relation to patient age, sex, body mass index (BMI), levels with implants, preoperative ROM, prosthesis size, and prosthesis position.

Results.

At the last follow-up visit, mean ROM of the disc prostheses was significantly increased from 4.23 ±3.12° to 6.81 ±3.76° at L3–4, and from 3.66 ±2.47° to 6.09 ±2.11° at L4–5. Mean ROM at L5–S1, however, was decreased from 3.12 ±1.56° to 2.86 ±1.26° (p > 0.05). This difference in the changes in postoperative ROM between L5–S1 and the other operated levels was the only statistically significant factor (p = 0.025) among the variables related to the postoperative ROM that the authors assessed, but other factors such as patient age, sex, BMI, disc height, and the size and position of the prosthesis were not related to segmental ROM.

Conclusions.

The data demonstrate that after TDR using the ProDisc II prosthesis, ROM of the prosthesis at L5–S1 is significantly lower compared with ROM at the other levels. In preserving ROM, the advantage of lumbar TDR using the ProDisc II might be minimal at L5–S1. Among the variables related to postoperative ROM, the level at which the ProDisc II prosthesis was implanted was the only one found to be statistically significant.
Extension of contained rupture of an abdominal aortic aneurysm into a lumbar intervertebral disc
Authors: Sakai Toshinori , Katoh Shinsuke , Sairyo Koichi , Higashino Kosaku , Hirohashi Nori , Yasui Natsuo
Published: January 2008

✓Chronic contained rupture of an abdominal aortic aneurysm (AAA) is a rare event, making its diagnosis difficult. A delayed diagnosis and delayed surgical repair compromise the outcome. In this paper the authors report the case of a chronic contained rupture of an AAA causing spinal destruction, in which diagnosis was difficult because the lesion produced symptoms mimicking those of pyogenic spondylitis
Mortality rates in geriatric patients with spinal cord injuries
Authors: Fassett Daniel R. , Harrop James S. , Maltenfort Mitchell , Jeyamohan Shiveindra B. , Ratliff John D. , Anderson D. Greg , Hilibrand Alan S. , Albert Todd J. , Vaccaro Alexander R. , Sharan Ashwini D.
Published: January 2008

Object

The authors undertook this study to evaluate the incidence of spinal cord injury (SCI) in geriatric patients (≥ 70 years of age) and examine the impact of patient age, extent of neurological injury, and spinal level of injury on the mortality rate associated with traumatic SCI.

Methods

A prospectively maintained SCI database (3481 patients) at a single institution was retrospectively studied for the period from 1978 through 2005. Parameters analyzed included patient age, admission American Spinal Injury Association (ASIA) motor score, level of SCI, mechanism of injury, and mortality data. The data pertaining to the 412 patients 70 years of age and older were compared with those pertaining to the younger cohort using a chi-square analysis.

Results

Since 1980, the number of SCI-related hospital admissions per year have increased fivefold in geriatric patients and the percentage of geriatric patients within the SCI population has increased from 4.2 to 15.4%. In comparison with younger patients, geriatric patients were found to be less likely to have severe neurological deficits (greater percentage of ASIA Grades C and D injuries), but the mortality rates were higher in the older age group both for the period of hospitalization (27.7% compared with 3.2%, p < 0.001) and during 1-year follow-up. The mortality rates in this older population directly correlate with the severity of neurological injury (1-year mortality rate, ASIA Grade A 66%, Grade D 23%, p < 0.001). The mortality rate in elderly patients with SCI has not changed significantly over the last two decades, and the 1-year mortality rate was greater than 40% in all periods analyzed.

Conclusions

Spinal cord injuries in older patients are becoming more prevalent. The mortality rate in this patient group is much greater than in younger patients and should be taken into account when aggressive interventions are considered and in counseling families regarding prognosis.
Serum creatine phosphokinase as an indicator of muscle injury after various spinal and nonspinal surgical procedures
Authors: Arts Mark P. , Nieborg Arjan , Brand Ronald , Peul Wilco C.
Published: January 2008

Object

Muscle injury is inevitable during surgical exposure of the spine and is quantified by the release of creatine phosphokinase (CPK). No studies have been conducted on different spinal approaches and nonspinal surgery with regard to muscle injury. The present prospective cohort study was conducted to evaluate the results of postoperative serum CPK as an indicator of muscle injury in relation to various spinal and nonspinal procedures.

Methods

The authors analyzed data in 322 consecutive patients who had undergone 257 spinal and 65 nonspinal procedures. Primary procedures were performed in 264 patients and revision surgeries in 58. Spinal procedures were subdivided according to the degree of surgical invasiveness as follows: minimally invasive (microendoscopic lumbar discectomy, unilateral transflaval discectomy, and minithoracotomy), average invasiveness (bilateral lumbar discectomy, laminectomy, and anterior cervical discectomy), and extensive surgery (instrumented single or multilevel spondylodesis of the entire spinal column). Spinal localization, number of spinal levels involved, surgical approach, duration of surgery, and body mass index (BMI) were recorded. Creatine phosphokinase was measured before surgery and 1 day after surgery, and the CPK ratio (that is, the difference within one patient) was used as the outcome measure.

Results

There was a significant dose-response relationship between the CPK ratio and the degree of surgical invasiveness; extensively invasive surgery had the highest CPK ratio and minimally invasive surgery had the lowest. Thoracolumbar surgery had a significantly higher CPK ratio compared with those for cervical and nonspinal surgery. There was a slightly negative relationship between the number of spinal segments involved and the CPK ratio. The CPK ratio in revision surgery was significantly higher than in primary surgery. Posterior surgical approaches had a higher CPK ratio, and the ratios for unilateral compared with bilateral approaches were not significantly different. The duration of surgery and preoperative serum level of CPK significantly influenced postoperative CPK. There was also a significant association between CPK ratio and nonspinal surgery. Age, sex, and BMI were not significant factors.

Conclusions

Data in this study have shown a dose-response relationship between CPK and the extent of surgical invasiveness. Thoracolumbar surgery, posterior approaches, duration of surgery, revision surgery, and preoperative value of CPK were significant influencing factors for the CPK ratio. The clinical significance of the results in the present study is not known.
Transdural approach for calcified central disc herniations of the upper lumbar spine
Authors: Choi Jeong-Wook , Lee Jung-Kil , Moon Kyung-Sub , Hur Hyuk , Kim Yeon-Seong , Kim Soo-Han
Published: January 2008

✓Disc herniations of the upper lumbar spine (L1–2 and L2–3) have a frequency of 1 to 2% of all disc herniations. During posterior discectomy after laminectomy, significant manipulation of the exiting nerve root is unavoidable because of the narrow lamina and the difficulty in mobilizing the nerve root. The authors adopted a transdural approach in patients with calcified central disc herniation at the L1–2 level to reduce the risk of nerve root injury.

Four patients suffering from radiating pain together with back pain were treated using the transdural approach. Pre-operative neuroimaging studies revealed severe central disc herniation with calcification at the L1–2 level. After laminectomy or laminotomy, the incised dura mater was tacked, and the cauda equina rootlets were gently retracted. An intentional durotomy was performed over its maximal bulging of the ventral dura. After meticulous dissection of dense adhesions between the disc herniation and the dural sac, adequate decompression with removal of calcified disc fragments and osteophytes was accomplished.

Clinical symptoms improved in all patients. Postoperative permanent cerebrospinal fluid leakage and pseudomeningocele were not observed, and no patient had a progressive lumbar deformity at an average follow-up of 53 months. Transient mild motor weakness and sensory change were observed in two patients postoperatively; however, these symptoms resolved completely within 1 week.

The posterior transdural approach offers an alternative in central calcified upper lumbar disc herniation when root retraction is dangerous.