bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychiatric Illness in Women: A Review of the Function of a Specialist Mother-Baby Unit
Authors: Milgrom Jeannette , Burrows Graham D. , Snellen Martien , Stamboulakis Wynne , Burrows Kerryn
Published: January 2008

Objective: The aim of this paper is to describe a specialist program in a psychiatric mother-baby unit and to review the characteristics (including mothering skills) and outcomes on discharge of 36 women consecutively admitted to the unit over an intensive 6-month observation period. Changes in admissions to the same unit over 10 years were also compared.

Method: Consecutive admissions were studied in terms of demographics, ethnicity, diagnosis, psychiatric history, psychiatric information and mother-infant data.

Results: The majority of women admitted suffered from schizophrenia or other psychotic disorders, with the second largest diagnostic criteria being depression. For 20 mothers, this was the first psychiatric admission and most admissions were voluntary. The mean length of stay was 21.7 days, representing a highly significant decrease in stay when compared to the past 10 years in the same unit. Mothering skills were found to be incompetent or only passable in 57% of women. A small improvement occurred by discharge, and the majority of women were not separated from their infants.

Conclusions: The critical need to support these women and their infants in the long term was highlighted, with recommendations of outpatient and day programs, as well as supported accommodation.
Neural Network Subtyping of Depression
Authors: Florio Tony M. , Parker Gordon , Austin Marie-Paule , Hickie Ian , Mitchell Philip , Wilhelm Kay
Published: January 2008

Objective: To examine the applicability of a neural network classification strategy to examine the independent contribution of psychomotor disturbance (PMD) and endogeneity symptoms to the DSM-III-R definition of melancholia.

Method: We studied 407 depressed patients with the clinical dataset comprising 17 endogeneity symptoms and the 18-item CORE measure of behaviourally rated PMD. A multilayer perceptron neural network was used to fit non-linear models of varying complexity. A linear discriminant function analysis was also used to generate a model for comparison with the non-linear models.

Results: Models (linear and non-linear) using PMD items only and endogeneity symptoms only had similar rates of successful classification, while non-linear models combining both PMD and symptom scores achieved the best classifications.

Conclusions: Our current non-linear model was superior to a linear analysis, a finding which may have wider application to psychiatric classification. Our non-linear analysis of depressive subtypes supports the binary view that melancholic and non-melancholic depression are separate clinical disorders rather than different forms of the same entity. This study illustrates how non-linear modelling with neural networks is a potentially fruitful approach to the study of the diagnostic taxonomy of psychiatric disorders and to clinical decision-making.
Weight Changes during Clozapine Treatment
Authors: Briffa Dianne , Meehan Thomas
Published: January 2008

Objective: The aim of this study was to assess the prevalence and magnitude of weight changes pre- and post-clozapine and to explore the ability of demographic and clinical factors to predict weight gain at 12 months post-clozapine.

Method: Weight changes in a sample of 51 patients were assessed at 3 months pre-clozapine, at baseline, and at 3 and 12 months post-clozapine. In addition, demographic data and information concerning changes in appetite and activity level at 3 months was gathered and used to predict weight gain at 12 months.

Results: Seventy percent of patients gained an average of 7.5 kg (10.6% increase in baseline body weight) over the 12-month period. Although post-clozapine weight gain for the total group was significant at 12 months, weight gain for the female sub-sample (n = 16) did not reach significance at either the 3 or 12 month assessments. The only factors associated with marked weight gain (> 15% increase) at 12 months were increased food intake early in treatment and having gained weight at 3 months.

Conclusion: Clozapine treatment was found to be associated with significant weight gain in patients prescribed clozapine, especially male patients. Considering the long-term health risks associated with excess weight gain, health professionals can play an important role in educating clients about the potential for weight gain with clozapine treatment.
Hippocrates, Galen, and the uses of trepanation in the ancient classical world
Authors: Missios Symeon
Published: January 2008

✓Trepanation (ανατρησιζ) is the process by which a hole is drilled into the skull, exposing the intracranial contents for either medical or mystical purposes. It represents one of the oldest surgical procedures, and its practice was widespread in many ancient cultures and several parts of the world. Trepanation was used in ancient Greece and Rome, as described in several ancient texts. Hippocrates and Galen are two of the most prominent ancient Greek medical writers, and their works have influenced the evolution of medicine and neurosurgery across the centuries. The purpose of this paper is to examine Hippocrates' and Galen's written accounts of the technique and use of trepanation in the ancient Greek and Roman world. Examination of those records reveals the ancient knowledge of neurological anatomy, physiology, and therapeutics, and illustrates the state and evolution of neurosurgery in the classical world.
The fate of medical knowledge and the neurosciences during the time of Genghis Khan and the Mongolian Empire
Authors: Safavi-Abbasi Sam , Brasiliense Leonardo B. C. , Workman Ryan K. , Talley Melanie C. , Feiz-Erfan Iman , Theodore Nicholas , Spetzler Robert F. , Preul Mark C.
Published: January 2008

✓In 25 years, the Mongolian army of Genghis Khan conquered more of the known world than the Roman Empire accomplished in 400 years of conquest. The recent revised view is that Genghis Khan and his descendants brought about “pax Mongolica” by securing trade routes across Eurasia. After the initial shock of destruction by an unknown barbaric tribe, almost every country conquered by the Mongols was transformed by a rise in cultural communication, expanded trade, and advances in civilization. Medicine, including techniques related to surgery and neurological surgery, became one of the many areas of life and culture that the Mongolian Empire influenced.
Soul searching: a brief history of the mind/body debate in the neurosciences
Authors: Dolan Brian
Published: January 2008

✓Anatomical and physiological understandings of the structure and function of the brain have worked to establish it as the “seat of the soul.” As an organ of reflection, meditation, and memory, the brain becomes synonymous with what defines the “self” through the existence of consciousness—of mind. Thus, the brain has been associated with a range of transcendent concepts—the soul, spirit, mind, and consciousness—that all relate in fundamental ways to each other both in terms of their perceived location within the brain and because of the way each works ultimately to define the person to whom the brain belongs. In this article, the author provides a brief exploration of how interrelated these categories have been when seen in the context of ancient, Renaissance, early modern, and modern philosophical and medical concerns; how the brain has variously been perceived as home to these intimate states of being; and how practitioners from the neurosciences have reflected on these questions. The author provides novel insights into the interrelationships of philosophy, theology, and medicine by examining these issues through the lens of the history of neuroscience.
Emergence and optimization of upright posture among hominiform hominoids and the evolutionary pathophysiology of back pain
Authors: Filler Aaron G.
Published: January 2008

✓The lordotic region of the lumbar spine is a significant focus of pain and dysfunction in the human body, and its susceptibility to disorders may reflect its substantial reconfiguration during the course of human evolution. The basic anatomy of the lumbar vertebra in Old World Monkeys and Early Miocene apes, or proconsulids, retains typical mammalian architecture. The lumbar vertebra in humans is different in the repositioning of the lumbar transverse process dorsal to the vertebral body rather than originating on the body itself and in the loss of the styloid process that is adjacent to the facets in other primates. These two features appeared in Morotopithecus bishopi 21.6 million years ago, suggesting that this ape is the founder of an upright hominiform lineage. The iliocostalis lumborum muscles migrated onto the iliac crest approximately 18 million years ago, becoming a powerful lateral flexor muscle of the trunk. The posterior superior iliac spine shifted far dorsal to the longissimus insertion in the genus Homo between 1 and 2 million years ago, making this muscle a powerful extensor of the lumbar spine. Functionally, the establishment of strong muscular flexors and extensors adds dynamic compressive stresses to the lumbar disks and also makes these muscles susceptible to strain.
Minimal tethered cord syndrome: what's necessary to justify a new surgical indication?
Authors: Selden Nathan R.
Published: January 2008

✓Traditionally, surgical division of the terminal filum (filum terminale) has been reserved for patients with imaging-apparent spinal cord tethering. The occurrence of medically refractory voiding dysfunction of neurogenic origin, without magnetic resonance (MR) imaging documentation of abnormality in the spine, has been termed “minimal” tethered cord syndrome (TCS). The rationale for and utility of using surgical division of the terminal filum in the treatment of minimal TCS are unproven.

Six studies that involved surgical division of the terminal filum for minimal TCS were identified and reviewed. A seventh study conducted prior to the MR imaging era, in which authors used myelography, was also included. In addition, two investigations of the clinicopathological findings in such cases were analyzed. A tripartite criterion for justifying the introduction of a new surgical indication is proposed and analyzed in light of this evidence.

In children with minimal TCS there are definite pathological changes in the terminal filum that are not visible on routine spinal MR imaging. These changes suggest that the pathophysiology of minimal TCS, like TCS that is demonstrated on neuroimaging, may involve abnormal traction on the distal spinal cord. Additional data are needed regarding the sensitivity and specificity of various clinical studies intended to identify children with minimal TCS. All existing data supporting the efficacy of surgery for minimal TCS have been generated by Class III studies. Clinical equipoise exists for this surgical indication, and, therefore, a prospective randomized trial should be completed.
The horizontal sacrum as an indicator of the tethered spinal cord in spina bifida aperta and occulta
Authors: Tubbs R. Shane , Bui Cuong J. , Loukas Marios , Shoja Mohammadali M. , Oakes W. Jerry
Published: January 2008

Object

The authors report on symptomatic patients with myelomeningocele (MMC) and lipomyelomeningocele (LMMC) who were found to have changes in their lumbosacral angle (LSA) corresponding to the onset of symptoms indicative of a tethered spinal cord.

Methods

The authors review data obtained in these two cohorts of patients and compare the LSAs measured in the perinatal period with those seen when the patients presented with symptoms of a tethered spinal cord.

Results

Children with LMMC, roughly one third of studied cases, were symptomatic due to a tethered spinal cord at their most recent follow-up. In children in whom the MMC was the closed form at birth, 20 of 30 had symptoms that could be indicative of a tethered spinal cord at their most recent follow-up. The LSA was altered in both groups with symptoms.

Conclusions

Signs and symptoms indicative of a tethered spinal cord appear to correspond to increases in the LSA.
Radiation-induced meningioma following radiation therapy for pituitary adenoma
Authors: Lyons Mark K. , Gonzales Gilbert R. , Schild Steven E. , Nelson Kent D.
Published: January 2008

The authors report the long-term result of treatment of a presumed pituitary adenoma with external-beam radiation therapy, which appears to be the development of a radiation-induced meningioma. Of the post radiation neoplasms that have been reported, meningiomas constitute a large proportion of these lesions.
Indications and results of combined anterior-posterior approaches for spine tumor surgery
Authors: Sundaresan Narayan , Steinberger Alfred A. , Moore Frank , Sachdev Ved Parkash , Krol George , Hough Laura , Kelliher Kevin
Published: January 2008

Spinal instrumentation currently allows gross-total resection and reconstruction in cases of malignancies at all levels of the spine. The authors analyzed the results in 110 patients who underwent surgery for primary and metastatic spinal tumors over a 5 year period (1989–1993) at a single institution. Major primary sites of tumor included breast (14 cases), chordoma (14 cases), lung (12 cases), kidney (11 cases), sarcoma (13 cases), plasmacytoma (10 cases), and others (36 cases). Prior to surgery, 55 patients (50%) had received prior treatment. Forty eight patients (44%) were nonambulatory, and severe paraparesis was present in 20 patients. Fifty three patients (48%) underwent combined anterior-posterior resection and instrumentation, 33 (30%) underwent anterior resection with instrumentation, 18 (16%) underwent anterior or posterior resection alone, and the remaining six patients (5%) underwent posterior resection and instrumentation. Major indications for anterior-posterior resection included three-column involvement, high-grade instability, involvement of contiguous vertebral bodies, and solitary metastases. Postoperatively, 90 patients improved neurologically. The overall median survival was 16 months, with 46% of patients surviving 2 years. Fifty-three patients (48%) suffered postoperative complications. Despite the high incidence of complications, the majority of patients reported improvement in their quality of life at follow-up review. Our findings suggest that half of all patients with spinal malignancies require combined anterior-posterior surgery for adequate tumor removal and stabilization.
Percutaneous balloon compression of the trigeminal nerve for treatment of trigeminal neuralgia
Authors: Brown Jeffrey A. , Chittum Christopher J. , Sabol David , Gouda Jan J.
Published: January 2008

The technique of percutaneous balloon compression for treatment of trigeminal neuralgia is demonstrated by using embedded audiovisual kernels. A text-based description with linked images is also provided to accomodate varying computer hardware capabilities. A new needle system for guiding the balloon catheter to the entrance of Meckel's cave and a balloon pressure monitoring system for the procedure is described and demonstrated. Results from a series of 141 consecutive patients treated during the period between 1983 and 1995 indicate an initial success rate of 92%. Fifty-seven percent of patients have postoperative numbness, which is described as mild to moderate by 94% of them. Sixteen percent have ipsilateral masseter-pterygoid weakness after compression. The overall recurrence rate is 26%. A Kaplan-Meier survival curve indicates that 60% of patients are pain free 8 years after surgery without recurrence requiring reoperation. The recurrence rate does not significantly differ from patients with first division pain to patients without first division involvement. An absent corneal reflex has not occurred, nor has anesthesia dolorosa. Balloon compression injures the myelinated fibers that mediate the “trigger” to the lancinating pain of trigeminal neuralgia. Because the corneal reflex is mediated by unmyelinated fibers, selective, monitored compression of myelinated fibers should preserve the corneal reflex when first division pain is present.
Continuous intraoperative electromyographic monitoring of cranial nerves during resection of fourth ventricular tumors in children
Authors: Grabb Paul A. , Albright A. Leland , Sclabassi Robert J. , Pollack Ian F.
Published: January 2008

The authors reviewed the results of continuous intraoperative electromyographic (EMG) monitoring of muscles innervated by cranial nerves in 17 children whose preoperative imaging studies showed compression or infiltration of the fourth ventricular floor by tumor to determine how intraoperative EMG activity correlated with postoperative cranial nerve morbidity. Bilateral lateral rectus (sixth) and facial (seventh) nerve musculature were monitored in all children. Cranial nerve function was documented immediately postoperatively and at 1 year.

Of the 68 nerves monitored, nine new neuropathies occurred in six children (sixth nerve in four children and seventh nerve in five). In five new neuropathies, intraoperative EMG activity could be correlated in one of four sixth nerve injuries and four of five seventh nerve injuries. Electromyographic activity could not be correlated in four children with new neuropathies. Of 59 cranial nerves monitored that remained unchanged, 47 had no EMG activity. Twelve cranial nerves (three sixth nerves and nine seventh nerves) had EMG activity but no deficit. Of four children with lateral rectus EMG activity, three had new seventh nerve injuries.

Lateral rectus EMG activity did not predict postoperative abducens injury. The absence of lateral rectus EMG activity did not assure preserved abducens function postoperatively. Likely because of the close apposition of the intrapontine facial nerve to the abducens nucleus, lateral rectus EMG activity was highly predictive of seventh nerve injury. Although facial muscle EMG activity was not an absolute predictor of postoperative facial nerve dysfunction, the presence of facial muscle EMG activity was associated statistically with postoperative facial paresis. The absence of facial muscle EMG activity was rarely associated with facial nerve injury. The authors speculate that EMG activity in the facial muscles may have provided important intraoperative information to the surgeon so as to avoid facial nerve injury.
Intracranial nerve repair: a review of experimental and clinical studies
Authors: Menovsky Tomas , van Overbeeke Jacobus J.
Published: January 2008

With recent developments in neurosurgery and related disciplines, more aggressive approaches are being made for various lesions of the skull base, and, as a consequence, cranial nerves are more frequently damaged, which causes significant morbidity. The authors review experimental and clinical studies involving surgical repair of severed cranial nerves and provide evidence that some degree of functional regeneration occurs. Functional recovery after repair is mainly dependent on the preoperative function of the muscle-nerve unit and the morphological organization of the nerve; the more complex the organization, the lesser the degree of functional recovery. The beneficial effect of surgical repair on postoperative morbidity is outlined together with suggestions for future research.
Hypoglossal-facial nerve side-to-end anastomosis for preservation of hypoglossal function: results of delayed treatment with a new technique
Authors: Sawamura Yutaka , Abe Hiroshi
Published: January 2008

This report describes a new surgical technique to improve the results of conventional hypoglossal-facial nerve anastomosis that does not necessitate the use of nerve grafts or hemihypoglossal nerve splitting.

Using this technique, the mastoid process is partially resected to open the stylomastoid foramen and the descending portion of the facial nerve in the mastoid cavity is exposed by drilling to the level of the external genu and then sectioning its most proximal portion. The hypoglossal nerve beneath the internal jugular vein is exposed at the level of the axis and dissected as proximally as possible. One-half of the hypoglossal nerve is transected: use of less than one-half of the hypoglossal nerve is adequate for approximation to the distal stump of the atrophic facial nerve. The nerve endings, the proximally cut end of the hypoglossal nerve, and the distal stump of the facial nerve are approximated and anastomosed without tension. This technique was used in four patients with long-standing facial paralysis (greater than 24 months), and it provided satisfactory facial reanimation, with no evidence of hemitongue atrophy or dysfunction.

Because it completely preserves glossal function, the hemihypoglossal-facial nerve anastomosis described here constitutes a successful approach in patients with long-standing facial paralysis who do not wish to have tongue function compromised.
Decompressive craniectomy in a rat model of “malignant” cerebral hemispheric stroke: experimental support for an aggressive therapeutic approach
Authors: Doerfler Arnd , Forsting Michael , Reith Wolfgang , Staff Christian , Heiland Sabine , Schäbitz Wolf-Rüdiger , von Kummer Rüdiger , Hacke Werner , Sartor Klaus
Published: January 2008

Acute ischemia in the complete territory of the carotid artery may lead to massive cerebral edema with raised intracranial pressure and progression to coma and death due to uncal, cingulate, or tonsillar herniation. Although clinical data suggest that patients benefit from undergoing decompressive surgery for acute ischemia, little data about the effect of this procedure on experimental ischemia are available. this article the authors present results of an experimental study on the effects of decompressive craniectomy performed at various time points after endovascular middle cerebral artery (MCA) occlusion in rats.

Focal cerebral ischemia was induced in 68 rats using an endovascular occlusion technique focused on the MCA. Decompressive cranioectomy was performed in 48 animals (in groups of 12 rats each) 4, 12, 24, or 36 hours after vessel occlusion. Twenty animals (control group) were not treated by decompression craniectomy. The authors used the infarct volume and neurological performance at Day 7 as study endpoints.

Although the mortality rate in the untreated group was 35%, none of the animals treated by decompressive craniectomy died (mortality 0%). Neurological behavior was significantly better in all animals treated by decompressive craniectomy, regardless of whether they were treated early or late. Neurological behavior and infarction size were significantly better in animals treated very early by decompressive craniectomy (4 hours) after endovascular MCA occlusion (p less than 0.01); surgery performed at later time points did not significantly reduce infarction size.

The results suggest that use of decompressive craniectomy in treating cerebral ischemia reduces mortality and significantly improves outcome. If performed early after vessel occlusion, it also significantly reduces infarction size. By performing decompressive craniectomy neurosurgeons will play a major role in the management of stroke patients.
Dual isotope single-photon emission computerized tomography used for prediction of histology and survival in patients after high-dose radiotherapy for malignant astrocytoma
Authors: Schwartz Richard B. , Holman B. Leonard , Garada Basem M. , Carvalho Paulo A. , Folkerth Rebecca , Schwartz Marc S. , Loeffler Jay S. , Shrieve Dennis C. , Polak Joseph F. , Black Peter McL. , Alexander Eben
Published: January 2008

This study was conducted to determine the sensitivity of dual-isotope single-photon emission computerized tomography (SPECT) in predicting tumor recurrence and survival in patients treated with high-dose radiotherapy for malignant gliomas.

Studies using SPECT with thallium-201 (Tl-201) and technetium-99m (Tc-99m) hexamethypropyleneamine oxime (HMPAO) in 50 consecutive patients with malignant astrocytomas treated by surgery and high-dose radiotherapy were performed 1 day before reoperation. Maximum uptake of Tl-201 in the lesion was expressed as a ratio to that of the contralateral scalp, and uptake of Tc-99m HMPAO was expressed as a ratio to that of the cerebellar cortex. Patients were stratified into groups based on maximum radioisotope uptake values in their tumor beds. Differences in tumor histopathology at reoperation and 1-year survival between SPECT groups were determined by using chi-square analysis.

The majority of patients in Group IA (Tl-201 ratio less than 2 or Tc-99m HMPAO ratio less than 0.5) showed radiation changes in their biopsy specimens (85.7%); they had an 85.7% 1-year survival rate. Group II (Tl-201 ratio between 2 and 3.5) had predominantly infiltrating tumor (78.6%); they had a 42% 1-year survival rate. Almost all of the patients in Group III (Tl-201 ratio greater than 3.5) had solid tumor (93.3%) and they had a 6.7% 1-year survival. Survival and pathological data differed significantly among groups (p less than 0.009).

Dual-isotope SPECT data correlates with histological findings on reoperation and postoperative survival in patients with malignant gliomas.
Functional imaging of cerebral arteriovenous malformations with a comment on cortical reorganization
Authors: Leblanc Richard , Meyer Ernst , Zatorre Robert , Klein Denise , Evans Alan
Published: January 2008

Functional brain imaging is poised to become a standard diagnostic tool. The authors review their experience using functional positron emission tomography (fPET) in patients with cerebral arteriovenous malformations (AVMs).

Twelve patients, three males and nine females aged 16 to 30 years, 11 with a cerebral AVM and one with a cavernous angioma, of which five were located in the central area and seven in a speech region, underwent fPET and three-dimensional magnetic resonance imaging. These studies were coregistered in stereotactic space and correlated to Brodmann's areas that were identified from the atlas of Talairach and Tournoux. Vibrotactile and/or motor stimulation of the contralateral hand were used to identify the central region in patients whose AVM resided within, or close to, the motor strip, and language tasks specifically designed to activate visual, auditory, expressive, or semantic language were used in patients whose AVM resided within, or close to, Broca's or Wernicke's areas.

Somatosensory and motor activation reliably identified the central region in all cases as validated by identification of Brodmann's areas and by intraoperative cortical mapping, which was performed with the patient under local anesthesia. Similarly, language tasks accurately lateralized major language function to one hemisphere concordantly with neuropsychological assessment, including dichotic listening and intracarotid Amytal tests, and localized language areas appropriately as verified by stereotactic coordinates.

Functional cerebral imaging is feasible in patients with structural brain lesions. It is a reliable method to identify the relationship of a cerebral AVM to the central region. The determination of a similar relationship to language areas is dependent on the development and further validation of language-based tasks designed to activate visual, auditory, expressive, and semantic aspects of language specific to particular sites within the anterior and posterior speech regions.
Preserved musical abilities following right temporal lobectomy
Authors: Koike Atsushi , Shimizu Hiroyuki , Suzuki Ichiro , Ishijima Buichi , Sugishita Morihiro
Published: January 2008

It has been widely accepted that the right temporal lobe plays a major role in the processing of music. One of the main lines of evidence was derived from Milner's study, published in 1962, which reported that right temporal lobectomy led to a decline in patient scores on four of the six subtests (Tonal Memory, Timbre, Loudness, and Time subtests) of the Seashore Measures of Musical Talents. That finding had led some surgeons and patients to hesitate in choosing right temporal lobectomy as a treatment for intractable epilepsy. The authors examined performance on the Seashore Measures before and after operations in 20 patients with right temporal lobectomy and nine patients with left temporal lobectomy. No disturbances in the Seashore Measures were detected after temporal lobectomy on either side. The extent of these temporal lobectomies was smaller than that of the temporal lobectomies in Milner's study, as measured along the sylvian fissure (1.5–4 cm; mean 2.7 cm, standard deviation (SD) 0.92 cm) and the base of the temporal lobe (3.5–5.5 cm; mean 4.7 cm, SD 0.63 cm). These findings indicate that the region resected on right temporal lobectomy in the present study is not essential for basic musical processing.
A new trend in operative technique for intracerebral hemorrhage: a comparative study of stereotactic endoscopic removal and stereotactic catheter drainage
Authors: Kim Myung-Hyun , Song Jun-Hyeok , Kim Sung-Hak , Park Dong-Bin , Shin Kyu-Man
Published: January 2008

The development of less invasive methods to evacuate intracerebral hematomas (ICHs) has improved outcome in patients with traumatic brain injury. Eighteen patients with ICHs underwent surgery via one of two methods: stereotactic endoscopic removal (SER) or stereotactic catheter drainage (SCD). The outcome results were then compared. The patient population was composed of 11 men and seven women with a mean age of 53.3 years (range 33-81 years), all suffering from ICH in the basal ganglia. The mean hematoma volume was 34.4 ml (range 23-105 ml). All patients had major neurological deficits, but showed no sign of transtentorial herniation.

Ten patients underwent SCD and eight had SER. All procedures were performed within 24 hours of insult. After local anesthesia was induced in the patient, an intracranial pressure (ICP) monitoring catheter and an Otzuki cannula were placed through separate burr holes in the skull. Using the SER technique, the ICH was removed using suction and forceps through the side window of the cannula until the ICP had decreased significantly. Hemostasis was attained by lesioning with a Nd-YAG laser. In the SCD procedure, we placed a silicone catheter into the hematoma to drain it and then added urokinase. The hematoma was drained for 3 to 5 days in the SER method and 7 to 10 days in the SCD method. Rebleeding occurred in one of the early cases in which we used the SER procedure. At follow-up evaluation, the mortality rate was 13% in the SER group and 10% in the SCD group. The patients in whom outcome was most improved from these treatments were those who had been admitted with an impaired level of consciousness.

Stereotactic catheter drainage is a precise, safe, and brief procedure with a very low rebleeding rate, but its outcome effect was more delayed than other procedures. Stereotactic endoscopic removal can easily replace SCD, with a similar mortality rate. Both procedures can be accomplished under direct visualization so as to eliminate any undesirable event or outcome.
Ultrasound-tailored functional hemispherectomy for surgical control of seizures in children
Authors: Kanev Paul M. , Foley Catherine M. , Miles Dan
Published: January 2008

Functional hemispherectomy techniques have been designed to minimize the long-term complications of anatomical resection without reducing the effectiveness of seizure control. The authors have used an ultrasound-guided approach tailored to combine temporal lobectomy with frontal and occipital disconnections with a central topectomy of the lateral, insular, and interhemispheric cortex. This technique achieves a comprehensive functional disconnection and minimizes entrance and manipulation within the body of the lateral ventricle. Eight patients ranging in age from 10 months to 23 years with congenital paresis and medically intractable seizures underwent functional hemispherectomy via this technique. The average surgical time was 4.5 hours, and blood loss ranged from 90 to 400 ml. All but one patient was discharged after 5 days. Postoperative fever syndromes, aseptic meningitis, and infection were avoided. On long-term follow-up evaluation (range l8-60 months, mean 38 months), seven of eight patients remain seizure free and were not on a course of anticonvulsant agents. Advantages of this technique include avoiding entrance within the ventricle, a more predictable postoperative period, and reduced postoperative complications.
Disappearing cervical disc
Authors: Westmark Richard M. , Westmark Kaye D. , Sonntag Volker K. H.
Published: January 2008

The authors report the case of a 48-year-old woman who experienced spontaneous resolution of a large herniated disc at C6-7. Spontaneous resolution of a herniated lumbar disc was first documented by computerized tomography. This case is another example of a rare spontaneous resolution of a cervical disc herniation documented by magnetic resonance imaging.
Intramedullary gadolinium-DTPA enhancement in a patient with cervical spondylotic myelopathy and an associated vascular lesion
Authors: Morimoto Tetsuya , Yamada Tomonori , Nagata Kiyoshi , Matsuyama Takeshi , Sakaki Toshisuke
Published: January 2008

Intramedullary enhancement of the cervical spinal cord is rare in chronic compression disease. An accompanying vascular lesion should be considered in such a case.

A 59-year-old man presented with severe cervical spondylotic myelopathy.

Gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) enhanced magnetic resonance imaging showed intramedullary enhancement at the C5`6 level, which was the most severely compressed level. A right ascending cervical arteriogram demonstrated a spinal arteriovenous fistula (AVF) fed mainly by the C-6 radicular artery and draining from the posterior medullary vein.

Surgery was performed to decompress the myelopathy and to obliterate the AVF. Postoperative MR imaging with Gd-DTPA enhancement showed immediate and complete disappearance of the previous enhancement. The intramedullary enhancement presumably resulted from the intraparenchymal hemodynamics due to the AVF.
Cerebral autoregulation following minor head injury
Authors: Jünger Elisabeth C. , Newell David W. , Grant Gerald A. , Avellino Anthony M. , Ghatan Saadi , Douville Colleen M. , Lam Arthur M. , Aaslid Rune , Winn H. Richard
Published: January 2008

The purpose of this study was to determine whether patients with minor head injury experience impairments in cerebral autoregulation. Twenty-nine patients with minor head injuries defined by Glasgow Coma Scale (GCS) scores of 13 to 15 underwent testing of dynamic cerebral autoregulation within 48 hours of their injury using continuous transcranial Doppler velocity recordings and blood pressure recordings. Twenty-nine age-matched normal volunteers underwent autoregulation testing in the same manner to establish comparison values. The function of the autoregulatory response was assessed by the cerebral blood flow velocity response to induced rapid brief changes in arterial blood pressure and measured as the autoregulation index (ARI).

Eight (28%) of the 29 patients with minor head injury demonstrated poorly functioning or absent cerebral autoregulation versus none of the controls, and this difference was highly significant (p = 0.008). A significant correlation between lower blood pressure and worse autoregulation was found by regression analysis in head-injured patients (r = 0.6, p < 0.001); however, lower blood pressure did not account for the autoregulatory impairment in all patients. Within this group of head-injured patients there was no correlation between ARI and initial GCS or 1-month Glasgow Outcome Scale scores. This study indicates that a significant number of patients with minor head injury may have impaired cerebral autoregulation and may be at increased risk for secondary ischemic neuronal damage.
Artificial neural networks: application to electrical stimulation of the human nervous system
Authors: North Richard B. , McNamee J. Paul , Wu Lee , Piantadosi Steven
Published: January 2008

Artificial neural networks are used increasingly in applications such as graphic pattern recognition, which are difficult to address with conventional statistical methods. In the management of chronic pain, graphic methods are used routinely; patients describe their patterns of pain using “pain drawings.” The authors have previously reported an automated, computerized pain drawing methodology, which has been used by patients with implanted spinal cord stimulators to represent a technical goal of the procedure, the overlap of pain by stimulation paresthesias. Standard linear discriminant statistical methods have shown associations between stimulation parameters and electrode positions as independent variables and technical outcome and relief of pain as dependent variables.

The authors have applied artificial neural networks to the problem of optimizing implanted stimulator adjustment. A data set of 3000 electrode combinations obtained in 41 patients was used to develop a linear discriminant statistical model on a mainframe computer and to train artificial neural networks on a personal computer. The performance of these two systems on a new data set obtained in 10 patients was compared with that of human “experts.” The best neural network model was marginally better than the linear discriminant model; the variance in patient ratings was predicted by these models to a degree that the human experts were unable to predict. The authors anticipate expanding the role of these models and incorporating them into expert sytems for clinical use.
Computerized tomography-guided percutaneous extralemniscal myelotomy
Authors: Kanpolat Yücel , Savas Ali , Çaglar Sükrü , Akyar Serdar
Published: January 2008

Extralemniscal myelotomy (ELM) is a procedure performed at the cervicomedullary junction of the spinal cord in which the central cord is lesioned to treat intractable pain. The neurophysiological mechanism of pain relief after ELM remains unclear. The authors present a series of 14 patients with intractable cancer pain who were managed by CT-guided, percutaneous ELM. In six of the cases (42.8%), total pain relief was achieved; partial satisfactory pain relief was attained in four cases (28.5%), and no pain control was achieved in four cases (28.5%). No complications due to ELM were observed. The authors believe that ELM is a safe and effective procedure in the management of intractable cancer pain for selected cases; computerized tomography guidance is an essential part of the procedure to achieve morphological localization of the target in the cervicomedullary junction. More research is needed to understand the neurophysiological mechanism of pain relief after ELM and to standardize the lesion volume.
Radiofrequency trigeminal rhizolysis for the treatment of trigeminal neuralgia secondary to brainstem infarction
Authors: Foroohar Mina , Herman Martin , Heller Scott , Levy Robert M.
Published: January 2008

Although percutaneous radiofrequency trigeminal rhizolysis (RFL) has been used to treat idiopathic trigeminal neuralgia thought secondary to multiple sclerosis, the use of RFL for trigeminal neuralgia caused by brainstem infarction has not been advocated. The authors report two patients with trigeminal neuralgia following pontine infarction in whom aggressive medical management failed, but who were successfully treated with RFL. Pain relief has persisted for the 3- and 6-year duration of follow-up examinations. Descending trigeminal reticular fibers may be affected by brainstem infarction and result in trigeminal neuralgia; thus, treatment by rhizotomy may be effective in decreasing the peripheral afferent input into the spinal trigeminal nucleus thus decreasing the pain. These two cases demonstrate the utility of RFL in the relief of ischemia-induced trigeminal neuralgia and lead the authors to suggest that its use be broadened to include this indication.
Lambdoid synostosis and occipital plagiocephaly: clinical decision rules for surgical intervention
Authors: Carson Benjamin S. , James Carol S. , VanderKolk Craig A. , Guarnieri Michael
Published: January 2008

Lambdoid craniosynostosis has been regarded as one of the least common categories of premature fusion of the cranial sutures, yet reports have suggested the incidence may be increasing. To guide treatment decisions, the authors describe a set of rules based on radiographic indicators and clinical assessment in the child. Experience suggests that children can have abnormal-appearing cranial sutures with normal neurological status and normal-appearing sutures with neurological deficits or marked cerebral compression. Early evaluation and follow-up treatment is essential for children with suspected craniosynostosis.
Albendazole and praziquantel treatment in neurocysticercosis of the fourth ventricle
Authors: Proaño Jefferson V. , Madrazo Ignacio , García Luis , García-Torres Elia , Correa Dolores
Published: January 2008

The purpose of this study was to determine the therapeutic efficacy of albendazole and praziquantel administration in the treatment of neurocysticercosis of the fourth ventricle. The authors report the results obtained in 10 patients with cystic neurocysticercosis of the fourth ventricle who were treated with albendazole at a dosage of 15 mg/kg/day for 2 weeks. Because of the failure of albendazole treatment, two of the patients received an additional course of praziquantel at a dosage of 100 mg/kg/day for 2 weeks. A total of 16 courses of albendazole and two courses of praziquantel were administered to the 10 patients. In seven patients (70%), there was complete disappearance of the cyst, in two others (20%) there was an important decrease in the size of the cyst, and in one (10%), no change was seen. None of the patients had complications during the follow-up period of between 6 and 26 months (average 15.7 months). The authors postulate that a regimen of albendazole is the treatment of choice for this type of neurocysticercosis, although praziquantel may also be useful.
Occipital plagiocephaly: a critical review of the literature
Authors: Rekate Harold L.
Published: January 2008

The objective of this review was to determine what information is available on the incidence, pathophysiology, late complications, and treatment paradigms for occipital plagiocephaly based on a critical review of the literature obtained from recognized databases in peer-reviewed scientific publications.

The content of this article is based on a critical review of the literature, and when discussing treatment options, classification of those articles with respect to the strength of the recommendations they contain.

Using standard computerized search techniques, databases containing medical literature were queried for key words related to occipital plagiocephaly beginning in 1966. Key words used for this search were: lambdoid, craniosynostosis, cranial sutures, facial asymmetry, torticollis, and plagiocephaly. Titles of all articles were scanned for relevance. Copies of all potentially relevant articles published in the English language were obtained and received at least a cursory review. Several articles not captured by these methods were found to be important when referenced in the articles obtained. Articles discussing treatment were divided into Class I, Class II, and Class III data for the purpose of deciding on their applicability to the development of a potential consensus for the treatment of this controversial condition.

Using the aforementioned key words, there were 4308 articles identified with potential relevance: scanning by title excluded all but 89. Of the 89, those with on-line abstracts were scanned, the remainder were obtained via interlibrary loan when needed for scanning of the article itself. The actual incidence of occipital plagiocephaly is unknown and there are no population-based studies of its incidence or prevalence. The reported incidence of lambdoid craniosynostosis ranges from 3 to 20% with the differences primarily due to differences in diagnostic criteria. With the possible exception of a lambdoid suture, which is replaced throughout its entire course by a dense ridge of bone, there are no other diagnostic criteria upon which there is agreement. There are no Class I and only one Class II studies in which a group of patients treated with one form of therapy is compared with another form of therapy or an untreated group. Treatment options that are recommended include observation only, mechanical treatments such as exercises, positioning, remodeling helmets, and a wide variety of surgical techniques. Very few reports accessed through the aforestated methodology report patients suffering any significant late effects of occipital plagiocephaly, although it may be morphometrically evident in as many as 14% of adults.

Controlled clinical trials will be needed before any form of intervention can be generally recommended. If surgery, which is expensive and potentially dangerous, is to continue to play a role in the management of this condition, efforts should be made to ascertain from the general population which patients who have not been treated have suffered from this lack of treatment.
Etiology of positional plagiocephaly in triplets and treatment using a dynamic orthotic cranioplasty device
Authors: Pomatto Jeanne K. , Littlefield Timothy R. , Manwaring Kim , Beals Stephen P.
Published: January 2008

In 1994 a set of triplets presented to the authors for treatment of their positional plagiocephaly with Dynamic Orthotic Cranioplasty (DOC™). The three 8-month-old infants were diagnosed with severe, moderate, and mild plagiocephaly. Only the severe and moderate cases were treated with the DOC band. The mild case was not treated with the DOC band because it was thought that the condition could be addressed through alteration in the child's sleeping position. The child with severe deformation required 8.5 months of treatment with two DOC bands and had significant residual asymmetries at the end of the treatment course. The child with moderate deformity required 2.5 months of treatment with only one DOC band and had excellent correction of the initial asymmetries. The results of their treatment provide a unique forum for discussing the etiology of positional plagiocephaly, as well as those factors that can influence the efficacy of DOC treatment.
Pallidal stimulation: an alternative to pallidotomy?
Authors: Tronnier Volker M. , Fogel Wolfgang , Kronenbuerger Martin , Steinvorth Sarah
Published: January 2008

A resurgence of interest in the surgical treatment of Parkinson's disease (PD) came with the rediscovery of posteroventral pallidotomy by Laitinen in 1985. Laitinen's procedure improved most symptoms in drug-resistant PD, which engendered wide interest in the neurosurgical community. Another lesioning procedure, ventrolateral thalamotomy, has become a powerful alternative to stimulate the nucleus ventralis intermedius, producing high long-term success rates and low morbidity rates. Pallidal stimulation has not met with the same success. According to the literature pallidotomy improves the “on” symptoms of PD, such as dyskinesias, as well as the “off” symptoms, such as rigidity, bradykinesia, and on-off fluctuations. Pallidal stimulation improves bradykinesia and rigidity to a minor extent; however, its strength seems to be in improving levodopa-induced dyskinesias. Stimulation often produces an improvement in the hyper- or dyskinetic upper limbs, but increases the “freezing” phenomenon in the lower limbs at the same time. Considering the small increase in the patient's independence, the high costs of bilateral implants, and the difficulty most patients experience in handling the devices, the question arises as to whether bilateral pallidal stimulation is a real alternative to pallidotomy.