bluuebunny/crossref_metadata_2025 huggingface dataset:
Natural Frequencies Reduction of RC Slab Subjected to Incremental Concentrated Loads
Authors: Ahmed Mezgeen S. , Yaseen Abdulhameed A. , Mohammad Fouad A.
Published: August 2019

Reinforced concrete slabs are frequently used in many engineering structures such as buildings and bridges. Damages in an engineering structure including reinforced concrete slab are classified as light, moderate, and severe cracks. A special treatment is required for every typical crack-damage to strengthen its structure. The reinforced concrete slab experiencing cracks reduce stiffness as well as its strength. An experimental program was set up to establish a relation between cracks and changes of a dynamic system characteristics of the slab through natural frequencies. The aim is to perform experimental modal analysis (EMA) as a non-destructive vibration testing method for diagnosing the structural integrity of the slab. For this purpose, two RC square slabs specimens of dimensions 1200mm x 1200mm x 40mm were used. As a first part of the project, a reinforced concrete slab was subjected to an increasing partially concentrated loads at the slab’s center to introduce cracks. After each incremental load steps (5, 10, 12kN) the slab was unloaded. Then, a free-free set-up for the slab was established by using the flexible elastic ropes (bungee cords). After the dynamic test of 5, 10 and 12kN loads, the slab was strengthened using external CFRP sheets (type TR30S). Next, experimental modal analysis was performed to establish a relation between cracks and changes in natural frequencies of the slab. The overall trend of frequency decrease after occurring damage that would be expected for all modes. However, it is not guaranteed all modes have same sensitivity to the applied load that inflicts severe cracks.
Face Recognition Based on Histogram Equalization and LBP Algorithm
Authors: Omar Herman Kh. , Tawfiq Nada E.
Published: August 2019

In the recent time bioinformatics take wide field in image processing. Face recognition which is basically the task of recognizing a person based on its facial image. It has become very popular in the last two decades, mainly because of the new methods developed and the high quality of the current visual instruments. There are different types of face recognition algorithms, and each method has a different approach to extract the image features and perform the matching with the input image.

In this paper the Local Binary Patterns (LBP) was used, which is a particular case of the Texture Spectrum model, and powerful feature for texture classification. The face recognition system consists of recognizing the faces acquisition from a given data base via two phases. The most useful and unique features of the face image are extracted in the feature extraction phase. In the classification the face image is compared with the images from the database.

The proposed algorithm for face recognition in this paper adopt the LBP features encode local texture information with default values. Apply histogram equalization and Resize the image into 80x60, divide it to five blocks, then Save every LBP feature as a vector table.

Matlab R2019a was used to build the face recognition system. The Results which obtained are accurate and they are 98.8% overall (500 face image).
Uji Aktivitas Antibakteri dari Isolat Daun Tendani (Goniothalamus Macrophyllus Hook. f. & Thomson.)
Authors: Wijaya Viriyanata , Supriyatna Supriyatna , Milanda Tiana
Published: August 2019

Tumbuhan tendani (Goniothalamus macrophyllus) secara empiris digunakan sebagai obat luar untuk infeksi kulit pada suku Dayak Punan. Penelitian ini bertujuan untuk mengetahui aktivitas senyawa aktif antibakteri yang terkandung dalam isolat dari fraksi etil asetat Daun G. macrophyllus. Fraksi etil asetat adalah fraksi teraktif yang diperoleh dari hasil pengujian aktivitas antibakteri. Isolat diperoleh dari proses pemisahan dan pemurnian menggunakan kromatografi kolom dan kromatografi lapis tipis preparatif. Isolat diuji dengan menggunakan metode difusi agar. Hasil uji aktivitas antibakteri isolat dengan konsentrasi 1,2 mg/50 Î¼L (2,4 %) terhadap S. aureus ATCC 25923 menghasilkan diameter zona hambat sebesar 7,85 mm.

Kata kunci : Goniothalamus macrophyllus, aktivitas antibakteri, Staphylococcus aureus, isolat, senyawa aktif
Naval Architecture: From Theory to practice
Authors: Luco Salman Richard , Flores Troncoso Rodrigo , Baos Ortiz Rodrigo
Published: August 2019

The complexity of projecting and designing a ship requires a work sequence that covers at least three main areas: (1) Concept engineering; (2) Basic engineering; (3) Detail engineering. This paper explains the design transition that exists (or should exist) between concept engineering and the final product, emphasizing the existing contractual relationship with the shipbuilder, especially in the initial definition of the project and the influence on construction aspects.
Design and construction of a prototype for the launch and recovery of a “SAAB SEAEYE FALCON” ROV for the diving and salvage department of the Colombian Navy
Authors: Rojas Rúa Jeison , Sánchez Mateus Héctor Ivan , Ovalle Porras Wilson , Casadiego Lissette
Published: August 2019

The divers of the Colombian Navy carry out search and salvage operations of equipment that are submerged in maritime or fluvial areas. To be effective, the diving and salvage department must have appropriate equipment to ensure the completion of the inspections carried out; however, since underwater dive inspections are carried out in difficult access or dangerous places, it is necessary to use specialized equipment such as remote operation vehicles - ROV, where the urgent need to implement a launching system for the immersion and subsequent extraction of such equipment is identified.

As a result of the existing problem, the project is built with the purpose of creating a prototype for the immersion and extraction of a “SAAB SEAEYE FALCON” ROV, thus facilitating inspections and reaching depths of 300 meters. For its construction, exploratory research was carried out and a deductive method was applied; modeling was performed using SolidWorks software as a tool for its construction that allowed identifying the best electromechanical structure, and the component to be used for its construction was identified through the study of pure and composite materials, which processes allowed designing and building a LARS prototype that met the operational objectives for which it was proposed.
PENGARUH SEDIAAN SALUT DAN PUPUK ORGANIK CAIR TERHADAP PERTUMBUHAN DAN HASIL KEDELAI (Glycine max L. Merril)
Authors: Erlinda Erlinda , Jamilah Jamilah , Herman Welly
Published: August 2019

Penelitian ini bertujuan untuk mengetahui interaksi pengaruh Sediaan Salut dan Pupuk Organik Cair Unitas Super terhadap pertumbuhan dan hasil kedelai (Glycine max.L Merril).  Penelitian ini menggunakan rancangan acak lengkap yang disusun secara faktorial dengan 2 perlakuan  dan 3 ulangan.  Faktor pertama sediaan salut terdiri atas 2 taraf yaitu tanpa salut SO (kontrol) dan S1 (1kg tanah + 1kg kompos + 100gr kapur +0,5 kg tanah bekas tanam kedelai + 10 gr pupuk PK), faktor ke 2 adalah aplikasi POC  yang terdiri atas 4 taraf yaitu 0 ml/L,10ml/L,20 ml/L,30 ml/L.  Hasil penelitian yang telah dilakukan menunjukkan bahwa pemberian tanpa Salut dan POC US pada taraf 30 ml/L  dapat meningkatkan tinggi tanaman, rasio tajuk akar, dan bobot 100 biji.Key words : kedelai, salut, pupuk organik cair
Using Deep Learning Methods for Intrusion Detection
Authors: Nechakhin V. A. , Pishchik B. N.
Published: August 2019

One of the ways of ensuring information security are intrusion detection systems (IDS). IDS are used to detect malicious activity on the network. The standard approach to the detection of attacks it is looking for specific patterns, such as byte sequences in network traffic, or known malicious instruction sequences used by malware. This approach is highly efficient, but it does not able to detect the attacks without patterns. Modern approaches to detection of attacks use deep learning.
The purpose of this work was to explore the possibility of building a universal classifier of network traffic based on a deep neural network. For this, a recurrent autoencoder was trained on TCP packets from the CICIDS2017 dataset. During training the neural network was a model in which the expected vector was set the same as the original one. And learning was on normal traffic. The main idea was that a recurrent autoencoder trained in this way should recover anomalous traffic with a high loss. The TCP package is considered malicious if the recovery loss is above the threshold. However, the accuracy of recovering normal TCP packets was low due to the insufficient model capacity and the lack of the suitable representation learning method.
After the results analyzing, we proposed an approach that can improve accuracy of detection for some attacks. Based on this approach, the VAEGAN network was trained on normal network flows from CICIDS2017. The VAEGAN was used to detect malicious network flows: to calculate the anomaly score for flow; if score is above the threshold – the flow is malicious.
The VAEGAN network showed a high percentage of attacks detection and the F-score value – 0.933.
Postoperative day 1 versus postoperative day 5 morning cortisol for predicting an intact hypothalamic-pituitary axis: A cohort analysis
Authors: Dupepe Esther , Patel Daxa , Miller Joseph , Rizo Ivania , Vaughan Tom Brooks , Riley Kristen
Published: August 2019

Background:

A reliable standard for evaluating postoperative hypothalamic-pituitary-axis (HPA) function following transsphenoidal pituitary surgery (TSS) could reduce hospital stays and unnecessary prolonged steroid therapy. We retrospectively examined the predictive role of morning cortisol levels on long-term HPA function to develop an institutional protocol. Here, we report the results of this analysis, which is the first to report the predictive strength of multiple variables (i.e., timing of measurement and values of serum cortisol cutoffs) within the same cohort.

Methods:

A retrospective chart review was performed in 183 patients at a single institution from 2007 to 2012. 67 patients met inclusion criteria. The predictive value of postoperative day (POD) 1 and POD 5 morning cortisol for HPA function as determined by 1 ug cosyntropin stimulation test was evaluated using standard confusion matrix calculations and receiver-operator control curve analysis.

Results:

In our cohort, an early POD 5 serum morning cortisol 15 ug/dl predicted an intact HPA axis with 100% specificity, 51% sensitivity, and a positive predictive value (PPV) of 100%. A POD 1 serum cortisol 25 ug/dl was needed to achieve a specificity of 100% and PPV of 100% to predict an intact HPA axis with a sensitivity of 30%. A POD 1 serum cortisol 18 ug/dl predicted an intact HPA axis with 33.3% specificity, PPV of 90.9%, and a sensitivity of 51.3%.

Conclusion:

A POD 5 morning cortisol level 15 ug/dl is an excellent predictor of normal postoperative HPA function in patients undergoing TSS for pituitary adenoma.
A noninvasive method for the estimation of increased intracranial pressure in patients with severe traumatic brain injury using optic nerve sheath diameter measured on computed tomography head
Authors: Majeed Gohar , Kashyap Samir , Menoni Rosalinda , Miulli Dan , Sweiss Raed
Published: August 2019

Background:

Measurement of optic nerve sheath diameter (ONSD) using ocular ultrasonography has shown a promise in predicting increased intracranial pressure (ICP). However, this method is dependent on operator technique and equipment availability. We propose an alternative method of measuring ONSD and Marshall score grading by utilizing initial computed tomography (CT) head obtained on admission. We believe that such a technique could help predict patients requiring an invasive ICP monitor on admission.

Methods:

Patients were retrospectively selected from the neurosurgery database of a level II trauma center. Control patients originated from a database of nontraumatic brain injury (TBI) patients with a negative CT head and no intracranial pathology. Study subjects included patients aged 18–90 years, who sustained a severe TBI requiring placement of an ICP monitor on admission. All patients had a non-contrast CT head before the placement of an ICP monitor. Patients receiving any intervention for decreasing suspected elevated ICPs and those with any documented orbital fractures before ICP monitor placement were excluded from the study. All measurements were performed by at least of two independent assessors.

Results:

A total of 242 patients were reviewed, of which 204 (100 control and 104 intervention) met inclusion criteria for this study. T he average age in the control group was 49.1 ± 22.9 years old while the average age of the intervention group was 36.9 ± 15.1 years (P <0.0001). The average Glasgow Coma Scale was 7 in the intervention group. The average ONSD of the control group was 5.73 ± 0.58 mm compared to 6.76 ± 0.83 mm in the intervention group (P <0.0001). Linear regression analysis demonstrated a statistically significant correlation between ONSD and opening ICP (r= 0.40,P< 0.001) and peak ICP (r= 0.31,P <0.0001). An ONSD 6.0 mm + Marshall score 3 on initial CT head demonstrated a 92.5% sensitivity, 92.6% specificity, and 96.1% positive predictive value for developing an ICP 20 mmHg during hospitalization.

Conclusion:

Utilizing ONSD in combination with Marshall score grading on initial CT head is a strong predictor of elevated ICP. These criteria can be used in future studies to develop more objective criteria to guide ICP monitor placement.
Computed tomography-guided navigated transcranial magnetic stimulation for preoperative brain motor mapping in brain lesion resection: A case report
Authors: Ferreira Pinto Pedro Henrique da Costa , Nigri Flavio , Caparelli-Dáquer Egas Moniz , Viana Jucilana dos Santos
Published: August 2019

Background:

Navigated transcranial magnetic stimulation (nTMS) is a well establish a noninvasive method for preoperative brain motor mapping. We commonly use magnetic resonance imaging (MRI) to supply the nTMS system. In some cases, MRI is not possible or available, and the use of computed tomography (CT) is necessary. We present the first report describing the association of CT and nTMS motor mapping for brain lesion resection.

Case Description:

CT imaging of a 59-year-old man suffering from acquired immune deficiency syndrome for 17 years, presenting with seizure and right hemiparesis, revealed a small single hypodense ring-enhancing lesion in the left central sulci suggesting cerebral toxoplasmosis. After 3 weeks of neurotoxoplasmosis treatment, due to four consecutive tonic-clonic seizures, a new CT scan was performed and showed no lesion changes. MRI was in maintenance at that time. Infectious diseases department suggested a brain lesion biopsy. Due to lesion’s location, we decided to perform a presurgical nTMS motor mapping. After a small craniotomy, we could precisely locate and safely totally remove the lesion. The pathology report revealed a high suspicious toxoplasmosis pattern. The patient was discharged after 2 days and continued toxoplasmosis treatment. After 6 months follow-up, he showed no signs of any procedure-related deficits or radiological recurrence.

Conclusion:

We report the feasibility and applicability of nTMS motor mapping using CT scan as an image source. It gives neurosurgeons another possibility to perform motor mapping for brain lesion removal, especially when MRI is not available or feasible.
Transnasal endoscopic removal of a retrochiasmatic cavernoma: A case report and review of literature
Authors: Zoia Cesare , Bongetta Daniele , Dorelli Gianluigi , Luzzi Sabino , Maestro Mattia Del , Galzio Renato J.
Published: August 2019

Background:

Cavernomas arising in the region of the optic apparatus are extremely rare, accounting for <1% of all the central nervous system cavernomas. Most patients are affected by acute visual disturbances related to hemorrhagic events. A prompt resection of the lesion together with a decompression of the optic apparatus may lead to a functional improvement. Almost all patients reported in literature were treated by means of a craniotomy, whereas only few papers described the use of a transnasal approach.

Case Description:

We report the case of a 53-year-old woman with a hemorrhagic, cavernous malformation of the optic chiasm region and we discuss the technical nuances of the endoscopic transnasal approach we employed. We also review literature for patients with cavernomas treated with a transsphenoidal approach. In our case, the patient underwent the gross-total resection of the lesion through a fully endoscopic transnasal route and the visual disturbances improved immediately after the operation. The ventral access allowed an adequate exposure of the chiasm/anterior circulation complex, thus avoiding an excessive dissection and retraction of neurovascular structures. Moreover, with the aid of angled scopes, we were able to identify the frail vascular supply of the chiasm by employing the suprachiasmatic corridor as well as the infrachiasmatic one. We stress the need for a careful reconstruction of the skull base to avoid a postoperative cerebrospinal fluid leak.

Conclusions:

With the evolution and spreading of the neuroendoscopic techniques, in selected cases, we advocate the use of the transnasal route for the removal of cavernomas arising in the region of the anterior optic pathways.
DistalCauda equinasyndrome: A case report of lumbosacral disc pathology and review of literature
Authors: Benko Michael J. , Danison Aaron P. , Marvin Eric A. , Saway Brian F.
Published: August 2019

Background:

Cauda equinasyndrome (CES) is an uncommon entity that presents acutely with all or some of the following symptoms; urinary incontinence from retention, fecal incontinence from loss of sphincter tone, saddle area hypoesthesia or anesthesia, and acute or progressive weakness in one or both lower extremities. The protean symptomatology is often mixed and is vulnerable to confounding comorbidities making the accurate and timely diagnosis of this syndrome uniquely challenging. Here, we present the case of a man who developed isolated sacral nerve dysfunction from CES in the midst of a diabetic crisis.

Case Description:

A 53-year-old male with a long history of uncontrolled Type 2 diabetes presented with acute-onset urinary and fecal incontinence, scrotal anesthesia, and a 3-day history of lower back pain with intermittent bilateral leg pain. This patient displayed no objective changes in leg strength, sensation, or reflexes. In addition, the patient tested positive for cocaine and had a blood glucose level of 800 mg/dL which confounded his clinical picture. The patient underwent bilateral laminectomies from L4–S1 with the removal of a large sequestered disc fragment from the S1–S2 disc space within 8 h of presentation with reasonable recovery.

Conclusion:

Highly variable presentations often confound the accurate and timely diagnosis of CES with severe implications on quality of life. Despite the limited functional recovery seen after surgical decompression, urgent or emergent intervention is paramount for treatment. Our patient’s presenting symptomatology and comorbidities highlight the need for practitioners to maintain a high index of suspicion in anyone with incontinence and back pain, regardless of distractors and even in the absence of other anticipated motor or sensory findings.
Surgical microanatomy of the occipital artery for suboccipital muscle dissection and intracranial artery reconstruction
Authors: Hatano Yuto , Ota Nakao , Noda Kosumo , Okada Yasuaki , Suzuki Yosuke , Fukuyama Shusei , Tanada Shuichi , Hashimoto Atsumu , Kondo Tomomasa , Miyazaki Takanori , Kinoshita Yu , Kamiyama Hiroyasu , Tokuda Sadahisa , Tanikawa Rokuya
Published: August 2019

Background:

The occipital artery (OA) is an important donor artery for posterior fossa revascularization. Harvesting the OA is difficult in comparison to the superficial temporal artery because the OA runs between suboccipital muscles. Anatomical knowledge of the suboccipital muscles and OA is essential for harvesting the OA during elevation of the splenius capitis muscle (SPL) for reconstruction of the posterior inferior cerebellar artery. We analyzed the running pattern of the OA and its anatomic variations using preoperative and intraoperative findings.

Methods:

From April 2012 to March 2018, we surgically treated 162 patients with suboccipital muscle dissection by OA dissection using the lateral suboccipital approach. The running pattern and relationship between the suboccipital muscles and OA were retrospectively analyzed using the operation video and preoperative enhanced computed tomography (CT) images. The anatomic variation in the running pattern of the OA was classified into two types: lateral type, running lateral to the muscle and medial type, running medial to the longissimus capitis muscle (LNG).

Results:

The medial pattern was observed in 107 (66%) patients and the lateral pattern in 54 (33.3%); 1 (0.6%) patient had the OA running between the LNGs.

Conclusion:

Preoperative CT is effective in determining the running course of the OA, which is important for safely harvesting the OA during SPL elevation. There is a risk of causing OA injury in patients with the lateral pattern. This is the first report showing that the OA rarely runs in between the LNGs.
Catheter fragment retrieved from an arterial branch of the right middle cerebral artery
Authors: Goland Javier , Yasuda Ezequiel , Monteverde Martín , Garbugino Silvia
Published: August 2019

Background:

Cerebral emboli is a rare complication of endovascular procedures and foreign bodies in the cerebrovascular system can lead to stroke. When an intravascular foreign body is identified, endovascular retrieval should be attempted due to its high success rate and minimal morbidity.

Case Description:

A 59-year-old male patient underwent cine-coronario-graphy through a trans-radial approach because of angina. During the study, a 6Fr catheter fragment ruptured, detached and migrated to a right middle cerebral artery branch. We recovered it with a coronary balloon.

Conclusion:

A coronary angioplasty balloon is an option for retrieving foreign objects or device fragments that have migrated into cerebral vasculature.
Supratentorial cavernoma and epilepsy: Experience with 23 cases and literature review
Authors: Khallaf Mohamed , Abdelrahman Mohamed
Published: August 2019

Background:

The current study aimed to assess the role of microsurgical treatment of patients with supratentorial cavernoma with epilepsy based on analysis of our patients.

Methods:

This retrospective study included 23 patients with supratentorial cavernoma on computed tomography (CT) scan and magnetic resonance imaging (MRI) of the brain admitted to the Department of Neurosurgery, Assiut University Hospitals (single tertiary hospital) between January 2014 and January 2018 (minimum 12-month follow-up). Deep-seated hemispheric and multiple cavernomas were excluded. Radiographs and hospital data of the patients were gathered and analyzed. All patients underwent the surgical procedure by one experienced neurosurgeon and the diagnosis was confirmed by pathologic evaluation.

Results:

A total of 23 patients underwent surgical intervention consist of 15 (65%) men and 8 (35%) women. Their age varies from 11 to 59 year with an average of 36.6 years. All patients presented with seizure. The supratentorial cavernomas were located commonly in temporal lobes; 9 patients (39.1%). 19 (83%) of cavernoma located in the left side. 18 (78%) of cavernoma had a size <2 cavernoma. Complete excision was confirmed in postoperative investigations (CT and MRI brain images). All 10 patients with only one seizure preoperatively were seizure free at follow-up. Of nine patients who had experienced between two and five seizures preoperatively, 7 (78%) were seizure free, and of four patients with numerous seizures preoperatively, 3 (75%) were seizure free.

Conclusion:

Our retrospective population study demonstrates an insight into the supratentorial cavernoma and suggests that microsurgical removal of the symptomatic cavernoma is generally accepted as the most effective and safe method.
Mutism resulting from heterochronic bilateral cerebellar hemorrhages – A case report
Authors: Katsuki Masahito , Narisawa Ayumi , Karibe Hiroshi , Kameyama Motonobu , Tominaga Teiji
Published: August 2019

Background:

Cerebellar mutism (CM) is a neurological condition characterized by lack of speech due to cerebellar lesions. Interruption of the bilateral dentatothalamocortical (DTC) pathways at midline structure seems the principal cause of CM but not fully understood. We described a rare case of CM due to heterochronic bilateral cerebellar hemorrhages.

Case Description:

An 87-year-old woman presented with depression of alertness after sudden vomiting. Neurologically, mild dysmetria and mutism were observed. The head computed tomography (CT) showed both a fresh right cerebellar hemorrhage and an obsolete left one. The patient was diagnosed as CM since both the thalamus and the supplementary motor area were bilaterally intact on both CT and magnetic resonance imaging. Medical treatment and rehabilitation improved her ataxia and ambulation. She became cognitively alert and could communicate by nodding, shaking her head, or facial expression. However, her mutism did not change at 4 months after the stroke.

Conclusion:

There are few reports on CM due to direct injuries to the bilateral dentate nuclei. Since our case did not show any injury other than bilateral dentate nuclei, this report can support the hypothesis that the interruptions of the bilateral DTC are the cause of CM.
An autopsy case of widespread brain dissemination of glioblastoma unnoticed by magnetic resonance imaging after treatment with bevacizumab
Authors: Hardian Ridzky Firmansyah , Goto Tetsuya , Kuwabara Haruki , Hanaoka Yoshiki , Kobayashi Shota , Kanno Hiroyuki , Shimojo Hisashi , Horiuchi Tetsuyoshi , Hongo Kazuhiro
Published: August 2019

Background:

Although glioblastoma has been shown to be able to disseminate widely in the intracranially after treatment with bevacizumab without any significant radiological findings, reports on such cases with subsequent autopsy findings are lacking.

Case Description:

A 36-year-old man presented with a general seizure and a mass of the right frontal lobe, which was diagnosed as diffuse astrocytoma (WHO Grade II). The patient underwent a total of four surgeries from 2005 to 2017. He showed tumor recurrence, progression, and malignant transformation to glioblastoma (GBM) (WHO Grade IV) despite repeated tumor resections, radiotherapy, and chemotherapies with temozolomide and carmustine wafers. Bevacizumab (10 mg/kg body weight) was started following the fourth surgery. After bevacizumab administration, the patient’s clinical condition improved to a Karnofsky performance status (KPS) score of 50–60, and he was stable for several months before finally deteriorating and passing away. Although sequential magnetic resonance imaging (MRI) showed shrinkage of the lesion and a reduction of edema, an autopsy showed widespread tumor invasion that was not revealed on MRI. Neoplastic foci were identified extensively in the cerebral cortex, basal ganglia, pituitary gland, cerebellum, and brainstem, imposing as gliomatosis cerebri.

Conclusion:

Imaging follow-up of malignant gliomas needs to be interpreted with caution as marked improvement in radiological response after bevacizumab treatment may not be indicating tumor regression. Despite the notable lack of evidence to increase overall survival in GBM patients with bevacizumab, the increase in progression-free survival and the observed relief of symptoms due to a decrease in edema should be considered relevant for patient management.
A Review of Complication Rates for Anterior Cervical Diskectomy and Fusion (ACDF)
Authors: Epstein Nancy E.
Published: August 2019

Background:

There are multiple complications reported for anterior cervical diskectomy and fusion (ACDF), one of the most common cervical spine operations performed in the US (e.g. estimated at 137,000 ACDF/year).

Methods:

Multiple studies analyzed the risks and complications rates attributed to ACDF.

Results:

In multiple studies, overall morbidity rates for ACDF varied from 13.2% to 19.3%. These included in descending order; dysphagia (1.7%-9.5%), postoperative hematoma (0.4%-5.6% (surgery required in 2.4% of 5.6%), with epidural hematoma 0.9%), exacerbation of myelopathy (0.2%-3.3%), symptomatic recurrent laryngeal nerve palsy (0.9%-3.1%), cerebrospinal fluid (CSF) leak (0.5%-1.7%), wound infection (0.1-0.9%-1.6%), increased radiculopathy (1.3%), Horner’s syndrome (0.06%-1.1%), respiratory insufficiency (1.1%), esophageal perforation (0.3%-0.9%, with a mortality rate of 0.1%), and instrument failure (0.1%-0.9%). There were just single case reports of an internal jugular veing occlusion and a phrenic nerve injury. Pseudarthrosis occurred in ACDF and was dependant on the number of levels fused; 0-4.3% (1-level), 24% (2-level), 42% (3 level) to 56% (4 levels). The reoperation rate for symptomatic pseudarthrosis was 11.1%. Readmission rates for ACDF ranged from 5.1% (30 days) to 7.7% (90 days postoperatively).

Conclusions:

Complications attributed to ACDF included; dysphagia, hematoma, worsening myelopathy, recurrent laryngeal nerve palsy, CSF leaks, wound infection, radiculopathy, Horner’s Syndrome, respiratory insufficiency, esophageal perforation, and instrument failure. There were just single case reports of an internal jugular vein thrombosis, and a phrenic nerve injury. As anticipated, pseudarthrosis rates increased with the number of ACDF levels, ranging from 0-4.3% for 1 level up to 56% for 4 level fusions.
Unnecessary Cervical Epidural Injection in An Octogenarian
Authors: Epstein Nancy E.
Published: August 2019

Background:

Epidural spine injections (ESI) have no documented long-term efficacy. Furthermore, cervical ESI uniquely risk intramedullary injections with resultant neurological deficits (e.g. monoplegia to quadriplegia), and intravascular vertebral injections (e.g. which potentially contribute to stroke, brain stem infarction).

Case Description:

A patient in his mid-eighties presented with 1 year’s duration of neck pain without any accompanying numbness, tingling or weakness in the upper or lower extremities. He had no radiculopathy, myelopathy, or neurological deficit. Two years earlier, the patient sustained a myocardial infarction (MI), requiring over 5 stents and a defibrillator. At the time of presentation, he was still on a baby ASA (81 mg/day), on anti-hypertensives, and cholesterol-lowering medications. His non-contrast cervical CT scan (patient had a pacemaker/defibrillator and could not have an MR) from the summer of 2018 showed no significant spinal cord or nerve root compression at any level. Nevertheless, he was subjected to two cervical epidural injections in the early fall; his baby ASA was stopped 5 days prior to each of these injections. Notably, this placed him at increased risk of MI and/or stroke. When he was seen by neurosurgery, without any neurological deficit or significant cervical radiographic findings, he was referred back to neurology for continued conservative management.

Conclusions:

Patients are increasingly subjected to epidural cervical spinal injections that have no documented long-term efficacy, and expose them to significant risks/complications. This 80+ year-old patient, without a neurological deficit or significant cervical CT-documented pathology, underwent 2 cervical ESI that unnecessarily exposed him to potential cardiac-stent related thrombosis (e.g. stopping ASA for 5 days-a bona-fide requirement for ESI to avoid acute epidural hematomas).
Skull base chordoma treated with proton therapy: A systematic review
Authors: Alahmari Mohammed , Temel Yasin
Published: August 2019

Background:

Chordoma located in the skull base is usually a challenging surgical condition. It is often not possible to achieve gross total resection. Residual tumors have been treated with adjuvant focal radiation therapy employing high-energy particles most commonly through proton beam. In this review, we systematically analyzed indications and outcomes of this treatment with respect to local control rates of the lesion and factors determining recurrence of skull base chordomas. In addition, we collected data on treatment-associated radiation-induced side effects.

Methods:

In line with the PRISMA guidelines, the authors performed a literature search algorithm for relevant articles using three databases: PubMed, Embase, and Cochrane. Inclusion and exclusion criteria were applied to evaluate all identified studies published between 1980 and 2018.

Results:

Our review included 11 studies for analysis (n = 511 patients). The mean age of the study population was 47.3 ± 5.8 years. The mean dose of postsurgical irradiation at the time of initial treatment was 71.1 ± 3.1 Gy. The mean follow-up duration was 45.0 ± 17.5 months. Within this follow-up duration, recurrence occurred in 26.8% of the patients. The mean time to recurrence was 34.5 ± 15.2 months. A significant number of patients experienced side effects varying from Grade 1 (mild dermatitis) to Grade 4 (temporal lobe necrosis and visual disorders).

Conclusion:

Despite advances in proton therapy, recurrence rates in skull base chordoma remain high. The toxicity of proton therapy may be more prevalent than generally thought. Unfortunately, there is substantial variation in the methods of data reporting.
Internal jugular phlebectasia: A systematic review
Authors: Figueroa-Sanchez Jose A. , Ferrigno Ana S. , Benvenutti-Regato Mario , Caro-Osorio Enrique , Martinez Hector R.
Published: August 2019

Background:

Internal jugular phlebectasia (IJP), the abnormal dilatation of internal jugular vein, is generally considered a benign anomaly. However, because IJP is uncommon, little is known about its natural history, and currently, no consensus on the best treatment modality is available.

Methods:

The purpose of this article is to conduct a systematic review of available literature on recently reported IJP cases to understand the main characteristics of IJP and its most frequent therapeutic approaches. Following the preferred reporting items for systematic reviews and meta-analyses guidelines, literature search for IJP cases was conducted in the COCHRANE, PUBMED, EBSCOHOST, SCOPUS, OVID, and SCIELO databases.

Results:

A total of 97 original articles were found, with a total of 247 IJP cases reported including both pediatric and adult patients.

Conclusions:

To the best of our knowledge, this study is the largest systematic review analyzing all the reported cases of IJP. IJP is considered by most authors as a benign abnormality that predominantly affects the right jugular vein. It is most commonly diagnosed in children. At present, conservative treatment is preferred for pediatric but not for adult patients. Multicenter randomized prospective studies are required to further understand this rare anomaly.
Endoscopic resection of the third ventricular epidermoid cysts: A case review and review of literature
Authors: Kashyap Samir , Cheema Bhagat , Chhabra Vaninder
Published: August 2019

Background:

Epidermoid cysts are benign, congenital lesions that originate from ectodermal cells, they are most commonly found in the cerebellopontine angle, but rarely in the ventricular system. There is limited literature regarding the different microsurgical techniques utilized to approach these lesions.

Methods:

A 63-year-old female with a recurrent third ventricular epidermoid cyst underwent gross total resection utilizing an endoscopic technique. We also reviewed the various endoscopic/microsurgical approaches and outcomes reported in literature.

Results:

We identified 15 cases, including our own. Nine of these were managed using microsurgical techniques, while six cases (including ours) were treated endoscopically; gross total resection was achieved in 10/15 cases (67%). Most commonly, surgeons utilized the interhemispheric transcallosal approach (five cases). Tumor recurrence was seen in two cases. Complications attributed to these resections included: disorders of the hypothalamic-pituitary axis (3) – diabetes insipidus, galactorrhea, and hypopituitarism; tumor recurrence (2); aseptic meningitis (1); and a transient Korsakoff syndrome (1).

Conclusion:

Epidermoid cysts of the third ventricle are exceedingly rare, and surgical resection is generally well tolerated. Microsurgical transcortical, transcallosal, and endoscopic approaches each have advantages and disadvantages, and are associated with unique procedure-specific complications. Continuing technological improvement would favor endoscopic approaches for resection of tumors of the third ventricle in the future.
Acquired Chiari I malformation due to lumboperitoneal shunt: A case report and review of literature
Authors: Hentati Aslam , Badri Mohamed , Bahri Kamel , Zammel Ihsen
Published: August 2019

Background:

The Type I malformations are supposed to be the result of mesodermal defects that create a congenitally small posterior fossa. However, Chiari malformation could be also “iatrogenic” and then called “acquired” Chiari I malformation. In this study, the authors report the clinical feature of a patient who developed a Chiari I malformation after lumboperitoneal shunt.

Case Description:

A 35-year-old woman has been suffering from idiopathic intracranial hypertension and rhinorrhea due to an anterior skull base defect. A valveless lumboperitoneal shunt followed by surgical closure of the defect was performed. Six months later, she suffered from major continuous occipital headaches. The neurological examination found a mild cerebellar gait ataxia and cerebellar dysarthria. The cerebral magnetic resonance imaging (MRI) showed a ptosis of the cerebellar tonsils and a disappearance of the cisterna magna; there was no syringomyelia. This herniation was not present before shunt was performed. A replacement of the lumboperitoneal shunt with a pressure-regulated valve chamber was performed. After a 1-year follow-up, the patient reports a marked decrease of the headache as well as the ataxia, and the last cerebral MRI showed resolution of the Chiari I malformation.

Conclusions:

Symptomatic acquired Chiari malformation with or without syringomyelia as a delayed complication after lumbar shunting is a rare complication, particularly reported in the pediatric population, but could also occur to adult patients. Treating these patients by correcting the shunt’s valve could be enough, but should be monitored, as it may fail to resolve the Chiari malformation even years after treatment.
Acute paradoxical brain herniation after decompressive craniectomy for severe traumatic brain injury: A case report
Authors: Hiruta Ryo , Jinguji Shinya , Sato Taku , Murakami Yuta , Bakhit Mudathir , Kuromi Yosuke , Oda Keiko , Fujii Masazumi , Sakuma Jun , Saito Kiyoshi
Published: August 2019

Background:

Sinking skin flap syndrome or paradoxical brain herniation is an uncommon neurosurgical complication, which usually occurs in the chronic phase after decompressive craniectomy. We report a unique case presenting with these complications immediately after decompressive craniectomy for severe traumatic brain injury.

Case Description:

A 65-year-old man had a right acute subdural hematoma (SDH), contusion of the right temporal lobe, and diffuse traumatic subarachnoid hemorrhage with midline shift to the left side. He underwent an emergency evacuation of the right SDH with a right decompressive frontotemporal craniectomy. Immediately after the operation, his neurological and computed tomography (CT) findings had improved. However, within 1 h after the surgery, his neurological signs deteriorated. An additional follow-up CT showed a marked midline shift to the left, i.e., paradoxical brain herniation, and his skin flap overlying the decompressive site was markedly sunken. We immediately performed an urgent cranioplasty with the right temporal lobectomy. He responded well to the procedure. We suspected that a cerebrospinal fluid leak had caused this phenomenon.

Conclusion:

Decompressive craniectomy for severe traumatic brain injury can lead to sinking skin flap syndrome and/or paradoxical brain herniation even in the acute phase. We believe that immediate cranioplasty allows the reversal of such neurosurgical complications.
Intradural spinal arachnoid cyst contributing to sudden paraparesis
Authors: Watanabe Akira , Nakanishi Kinya , Kataoka Kazuo
Published: August 2019

Background:

Spinal arachnoid cysts are cystic lesions filled with cerebrospinal fluid that contributes to neurological deficits depending on their size/location within the spinal canal. Here, we report a patient with a spinal subarachnoid cyst who suddenly developed paraparesis.

Case Description:

A 37-year-old female with a thoracic spinal arachnoid cyst at the T7 level suddenly developed lower abdominal pain followed by immediate paraparesis. Two weeks following the onset of symptoms, she underwent a T6-T8 laminectomy; this included with full cyst excision. By the 4th postoperative week, her signs/symptoms fully resolved.

Conclusions:

A 37-year-old female with a T7 thoracic spinal subarachnoid cyst who presented with acute paraparesis regained normal function 2 weeks following a T6-T8 laminectomy.
The use of high-dose cervical spinal cord stimulation in the treatment of chronic upper extremity and neck pain
Authors: Baird Trey A. , Karas Chris S.
Published: August 2019

Background:

Dorsal column spinal cord stimulation is used for the treatment of chronic neuropathic pain of the axial spine and extremities. Recently, high-dose (HD) thoracic dorsal column stimulation for paresthesias has been successful. This study evaluates the utility of HD stimulation in the cervical spine for managing upper neck and upper extremity pain and paresthesias.

Methods:

Three patients suffering from cervical and upper extremity chronic pain were assessed. Each underwent a two-stage process that included a trial period, followed by permanent stimulator implantation. Therapy included the latest HD stimulation settings including a pulse width of 90 μs, a frequency setting of 1000 Hz, and an amplitude range of 1.5 amps–2.0 amps. Pain relief was measured utilizing relative percent pain improvement as self-reported by each patient before and after surgery.

Results:

After permanent implantation, (range 15–21 months), all three patients continued to experience persistent pain and paresthesia relief (70%–90%).

Conclusions:

In three patients, HD cervical spinal cord stimulation successfully controlled upper extremity chronic pain/paresthesias.
Chronic hypertrophic malunion of C2 Fracture causing cervical quadriparesis; Case report and focused literature review
Authors: Bashir Sanaullah Khan , Batool Syeda Maheen , Javed Gohar
Published: August 2019

Background:

Pseudarthrosis of Type II C2 odontoid fractures typically leads to displacement and subluxation resulting in canal compression/cervical myelopathy.

Case Description:

Here, we present a 43-year-old male who sustained cervical trauma 28 years ago. He now presented with an acute 10-day onset of quadriparesis attributed to a chronic malunion of an unstable type II odontoid fracture. He successfully underwent a circumferential decompression and fusion (e.g., warranting a trans-oral odontoidectomy followed by C1-C3 posterior fusion).

Conclusion:

Progressive cervical myelopathy attributed to a chronic malunion of a type II odontoid fracture may require circumferential decompression/stabilization (e.g., an anterior decompression with osteophyte resection and posterior C1-C3 spinal stabilization).
Bone cylinder plug and coil technique for accurate pedicle localization in thoracic spine surgery: A technical note
Authors: Maduri Rodolfo , Starnoni Daniele , Barges-Coll Juan , David Hajdu Steven , Michael Duff John
Published: August 2019

Background:

Intraoperative identification of the correct level during thoracic spine surgery is essential to avoid wrong-level procedures. Despite technological progress, intraoperative imaging modalities for identifying the correct thoracic spine level remain unreliable and often lead to wrong-level surgery. To counter potential wrong-level operations, here, we have proposed a novel pedicle/bone cylinder marking technique for use in the thoracic spine utilizing biplanar fluoroscopy and confirmed with computed tomography (CT).

Methods:

First, under fluoroscopic guidance, a bone cylinder is removed from the correct thoracic pedicle. Next, endovascular coils are packed into the cancellous bone defect followed by reinsertion of the bony plug. The patient then undergoes a CT scan of the entire thoracolumbosacral spine to precisely identify the marked level before surgery.

Results:

We utilized this bone cylinder plug/coil technique to identify the T9-T10 level in a 56-year-old female with a soft thoracic disc herniation. The index thoracic pedicle was successfully localized before performing the unilateral minimally invasive laminectomy followed by the transpedicular thoracic disc excision.

Conclusion:

The bone cylinder plug/coil technique is a safe and effective method for marking the correct level in thoracic spine surgery, while also reducing the operative time.
Oculomotor neuropathy from an unruptured arteriovenous malformation in the frontal operculum: A case report
Authors: Saiegh Fadi Al , Hines Kevin , Mouchtouris Nikolaos , Theofanis Thana , Jabbour Pascal , Rosenwasser Robert , Tjoumakaris Stavropoula
Published: August 2019

Background:

Cerebral arteriovenous malformations (AVMs) are vascular lesions with a network of dysplastic vessels between an arterial and a venous tree with no intervening capillary bed. They most commonly present with an acute hemorrhage, seizures, or persistent headaches.

Case Description:

The authors report the case of a 62-year-old male who presented with diplopia for 5 days. Magnetic resonance imaging and angiography demonstrated a Spetzler-Martin Grade 2 AVM located in the right frontal operculum with deep drainage into the basal vein of Rosenthal causing ipsilateral oculomotor neuropathy. The patient underwent staged embolizations of the feeding pedicles, which were derived from the internal as well as external carotid circulation. This was followed by a right pterional craniotomy for resection of the AVM. The patient reported complete resolution of the diplopia over 4 weeks with no recurrence at the 6-month follow-up appointment.

Conlusion:

AVMs of the brain can present with atypical clinical symptoms that can be caused by the venous drainage pattern not the location. It is important to include vascular imaging studies in the work-up of patients who present with diplopia to rule out an AVM. Early diagnosis and treatment of the AVM can result in complete resolution of the diplopia.
Cranial migration of lumboperitoneal shunt: A case report and review of literature
Authors: AlBakry Amr , Taha Mahmoud M. , Al Menshawy Hassan A.
Published: August 2019

Background:

Lumboperitoneal shunt is an easy and effective way of managing benign intracranial hypertension (BIH) and other causes of increased intracranial pressure. Yet, it is associated with a relative high failure rate. Proximal migration of the shunt is rare and only few cases have been reported.

Case Description:

Here, we present a case of a 16-year-old female, diagnosed with BIH, who had a proximal shunt migration 4 months after surgery and was managed conservatively, along with the review of literature.

Conclusion:

Although it is associated with a high complication rate, lumboperitoneal shunt is very effective in the management of many disorders. One of the most common complications is shunt migration. While many mechanisms explaining shunt migration have been hypothesized, the most important single preventing factor for preventing shunt migration remains proper fixation of the shunt.