bluuebunny/crossref_metadata_2025 huggingface dataset:
Ruptured aneurysm arising from a basilar artery fenestration and associated with a persistent primitive hypoglossal artery
Authors: Kanematsu Miyuki , Satoh Koichi , Nakajima Norio , Hamazaki Fusamitsu , Nagahiro Shinji
Published: May 2009

✓ A 42-year-old woman experienced the sudden onset of a severe headache. Angiograms demonstrated a persistent primitive hypoglossal artery (PHA) originating from the internal carotid artery at the C-2 vertebral level. In addition, a fenestration at the PHA—basilar artery (BA) junction and an aneurysm at the proximal end of this fenestration were revealed. To perform endovascular embolization of the aneurysm, a microcatheter was introduced into the aneurysm sac via the PHA and two Guglielmi Detachable Coils were placed in the aneurysm. The patient's postoperative course was uneventful, and she was able to resume her normal life. Although many clinical cases have been reported in which a ruptured aneurysm was associated with a PHA or a BA fenestration, as far as the authors know there has been no case in the literature in which a ruptured aneurysm associated with both anomalies and no case in which endovascular embolization was used to treat a ruptured aneurysm associated with a PHA. This rare case is discussed and a review of the relevant literature is presented.
The effect of nimodipine on cerebral oxygenation in patients with poor-grade subarachnoid hemorrhage
Authors: Stiefel Michael F. , Heuer Gregory G. , Abrahams John M. , Bloom Stephanie , Smith Michelle J. , Maloney-Wilensky Eileen , Grady M. Sean , Leroux Peter D.
Published: May 2009

Object. Nimodipine has been shown to improve neurological outcome after subarachnoid hemorrhage (SAH); the mechanism of this improvement, however, is uncertain. In addition, adverse systemic effects such as hypotension have been described. The authors investigated the effect of nimodipine on brain tissue PO2.

Methods. Patients in whom Hunt and Hess Grade IV or V SAH had occurred who underwent aneurysm occlusion and had stable blood pressure were prospectively evaluated using continuous brain tissue PO2 monitoring. Nimodipine (60 mg) was delivered through a nasogastric or Dobhoff tube every 4 hours. Data were obtained from 11 patients and measurements of brain tissue PO2, intracranial pressure (ICP), mean arterial blood pressure (MABP), and cerebral perfusion pressure (CPP) were recorded every 15 minutes.

Nimodipine resulted in a significant reduction in brain tissue PO2 in seven (64%) of 11 patients. The baseline PO2 before nimodipine administration was 38.4 ± 10.9 mm Hg. The baseline MABP and CPP were 90 ± 20 and 84 ± 19 mm Hg, respectively. The greatest reduction in brain tissue PO2 occurred 15 minutes after administration, when the mean pressure was 26.9 ± 7.7 mm Hg (p < 0.05). The PO2 remained suppressed at 30 minutes (27.5 ± 7.7 mm Hg [p < 0.05]) and at 60 minutes (29.7 ± 11.1 mm Hg [p < 0.05]) after nimodipine administration but returned to baseline levels 2 hours later. In the seven patients in whom brain tissue PO2 decreased, other physiological variables such as arterial saturation, end-tidal CO2, heart rate, MABP, ICP, and CPP did not demonstrate any association with the nimodipine-induced reduction in PO2. In four patients PO2 remained stable and none of these patients had a significant increase in brain tissue PO2.

Conclusions. Although nimodipine use is associated with improved outcome following SAH, in some patients it can temporarily reduce brain tissue PO2.
Early surgery-related complications after aneurysm clip placement: an analysis of causes and patient outcomes
Authors: Mclaughlin Nancy , Bojanowski Michel W.
Published: May 2009

Object. Most reports of series on ruptured intracranial aneurysms contain information on select intraoperative complications. An understanding of all surgical complications, however, may guide us toward improved surgical procedures and enrich discussions concerning alternative management strategies, such as endovascular treatment, which are not exempt from complications and aneurysm recurrence.

Methods. The study consists of a retrospective review of the charts, images, and notes from follow-up visits of 143 consecutive patients with subarachnoid hemorrhage (SAH) who were surgically treated during a 3-year period by one neurosurgeon. A surgical complication was determined based on findings of a clinical and/or radiological study in the absence of confounding factors such as the initial SAH ictus, vasospasm, hydrocephalus, and septic status. Functional outcome was assessed between 2 and 3 months post-SAH by using the Glasgow Outcome Scale (GOS). A procedure-related surgical complication was diagnosed in 29 (20.3%) of 143 patients studied. A brain tissue injury, including cerebral edema and hemorrhagic contusions, was diagnosed in 6.3% of patients, an unpredicted residual aneurysm neck in 5.3% of patients, and a cranial nerve deficit in 2.8% of patients. Functional outcome was good in 22 (75.9%) of the 29 patients with surgical complications. Death due to a surgical complication occurred in one (0.7%) of 143 patients.

Conclusions. Surgical complications are more prevalent than previously thought. They may have been overlooked previously because of the high percentage of good functional outcomes and low mortality rates in this group. The identification of surgical complications may encourage the search for solutions to improve surgical treatment of aneurysmal SAH.
Alpha2-adrenergic receptor subtype specificity of intrathecally administered tizanidine used for analgesia for neuropathic pain
Authors: Leiphart James W. , Dills Cynthia V. , Levy Robert M.
Published: May 2009

Object.Intrathecally administered α2-adrenergic receptor subtype—specific antagonists were used to determine which α2-adrenergic receptor subtype mediates the analgesic effect of intrathecally administered tizanidine in a chronic constriction injury (CCI) rat model of neuropathic pain.

Methods.Seven days after CCI and intrathecal catheter surgeries had been performed in Sprague—Dawley rats, baseline neuropathic pain tests including cold-floor ambulation and paw pinch were performed. Either the dimethyl sulfoxide vehicle (seven rats) or one of the antagonists—5, 23, or 46 µg yohimbine (22 rats); 5, 25, 50, or 100 µg prazosin (25 rats); or 5, 45, or 90 µg WB4101 (11 rats)—were intrathecally administered to the animals, followed in 30 minutes by 50 µg intrathecally administered tizanidine. The neuropathic pain tests were repeated 30 minutes later. The resulting profile showed a descending order of antagonist efficacy for yohimbine, prazosin, and WB4101 for the cold-floor ambulation test and for the paw-pinch test of the affected paw. As expected given tizanidine's lack of analgesic effect on the contralateral, normal paw, there were no effects of antagonists on contralateral paw responses. The results of the paw-pinch test on the affected side were compared with binding data cited in the existing literature for the three different α2-adrenergic receptor subtypes (α2A, α2B, and α2C) with yohimbine, prazosin, and WB4101. The antagonist response profile for the paw-pinch test of the affected paw most closely approximated the α2Breceptor binding profile.

Conclusions.The antagonist profile from the current study is most consistent with the theory that the α2B-adrenergic receptor subtype mediates the analgesic effect of intrathecally administered tizanidine on CCI-associated neuropathic pain.
Mismatch repair protein hMSH2 in primary drug resistance in in vitro human malignant gliomas
Authors: Rellecke Philipp , Kuchelmeister Klaus , Schachenmayr Walter , Schlegel Juergen
Published: May 2009

Object. The mismatch repair (MMR) system has previously been implicated in acquired chemoresistance in malignant gliomas in humans. Its impact on the primary chemoresistance in glioblastoma multiforme (GBM) has not been determined in detail, however.

Methods. The authors investigated the expression of both the MMR genes (hMSH2, hMLH1, hPMS1, hPMS2, and hMSH6) at the transcriptional level through reverse transcription—polymerase chain reaction and the hMSH2 protein through Western blot and immunohistochemical analysis of tumor tissue and primary cell cultures of 25 in vitro human de novo GBMs without prior experimental treatment. Results of these analyses were compared with data on in vitro chemoresistance to nine drugs that are in general use in glioma therapy.

All MMR genes were expressed in the GBMs, with no significant difference among the individual tumors except in one respect; that is, GBMs showed either relatively high levels or barely detectable levels of hMSH2 messenger (m)RNA and protein expression. All multiresistant tumors demonstrated high hMSH2 expression, and all but two of the sensitive tumors exhibited low hMSH2 mRNA levels.

Conclusions. Analysis of the data indicates that functional alterations of the MMR system are involved in the primary drug resistance in in vitro human malignant gliomas. Analysis of hMSH2 expression might therefore predict therapeutic responses in humans with GBMs.
Neuroprotective effect of peroxynitrite decomposition catalyst and poly(adenosine diphosphate—ribose) polymerase inhibitor alone and in combination in rats with focal ischemia
Authors: Sharma Shyam S. , Munusamy Shankar , Thiyagarajan Meenakshisundaram , Kaul Chaman L.
Published: May 2009

Object. The authors evaluated the neuroprotective effect of 5,10,15,20-tetrakis(N-methyl-4′-pyridyl)porphyrinatoiron(III) (FeTMPyP), a peroxynitrite decomposition catalyst, and 1,5-isoquinolinediol (ISO), a poly(adenosine diphosphate [ADP]-ribose) polymerase (PARP) inhibitor, alone and in combination in rats with focal cerebral ischemia induced by middle cerebral artery occlusion (MCAO).

Methods. Male Sprague—Dawley rats were subjected to 2 hours of MCAO followed by 22 hours of reperfusion. Cerebral infarction and neurological deficits were estimated after ischemia. Intraperitoneal injections of FeTMPyP (1 and 2 mg/kg) and ISO (0.05 and 0.1 mg/kg) were administered alone or in combination in ischemic animals. The PARP activity in vehicle- and drug-treated groups was estimated using anti—poly(ADP-ribose) antibody in immunofluorescence and immunoblotting studies.

Two hours of MCAO and 22 hours of reperfusion produced significant cerebral infarction and neurological deficits. Treatment with FeTMPyP (1 and 2 mg/kg) and ISO (0.05 and 0.1 mg/kg) produced a significant reduction in cerebral infarction and neurological deficits. Combination therapy (2 mg/kg FeTMPyP and 0.1 mg/kg ISO) enhanced the inhibition of ischemic volume (77.81 ± 0.86%) compared with monotherapies (FeTMPyP 54.07 ± 5.6% and ISO 53.06 ± 3.88%). Immunoblotting and immunofluorescence studies showed PARP activation after ischemia, which was reduced by drug treatment.

Conclusions. Neuroprotection observed with FeTMPyP and ISO alone and in combination may be attributed to inhibition of the peroxynitrite—PARP cascade of cerebral ischemia/reperfusion injury.
Bilateral cortical stimulation for deafferentation pain after spinal cord injury
Authors: Tani Naoki , Saitoh Youichi , Hirata Masayuki , Kato Amami , Yoshimine Toshiki
Published: May 2009

✓ The relief of intractable pain after spinal cord injury (SCI) is very difficult to obtain, even with dorsal root entry zone lesioning, spinal cord stimulation, and thalamic stimulation. Using bilateral motor cortex stimulation (MCS) the authors successfully treated a woman who experienced deafferentation pain 4 years after sustaining an SCI. To the authors' knowledge, this is the first report of bilateral MCS for pain relief after SCI. The success they achieved using this method indicates that MCS could be a new treatment option for deafferentation pain following SCI.
Persistent primitive trigeminal artery—cavernous sinus fistula with intracerebral hemorrhage: endovascular treatment using detachable coils in a transarterial double-catheter technique
Authors: Tokunaga Koji , Sugiu Kenji , Kameda Masahiro , Sakai Kyoji , Terasaka Kaoru , Higashi Toru , Date Isao
Published: May 2009

✓ Intracerebral hemorrhage occurred in this 61-year-old woman with preexisting diplopia and proptosis. Results of angiography demonstrated a persistent primitive trigeminal artery (PPTA)—cavernous sinus fistula with cortical venous reflux. Two microcatheters were introduced transarterially through the PPTA into the two draining pathways in the cavernous sinus. Coils were delivered in both pathways simultaneously to prevent further venous overload on either path. The fistula was successfully occluded without complication while the PPTA was preserved. The authors describe this double-catheter technique for coil embolization of a fistula and review the literature concerning PPTA—cavernous sinus fistulas.
Perfusion imaging of high-grade gliomas: a comparison between contrast harmonic and magnetic resonance imaging
Authors: Harrer Judith U. , Möller-Hartmann Walter , Oertel Markus F. , Klötzsch Christof
Published: May 2009

✓ Transcranial contrast harmonic (CH) imaging is emerging as a promising tool for the evaluation of brain perfusion. The authors report on two cases of histologically proven high-grade gliomas evaluated using CH imaging in comparison to perfusion magnetic resonance (pMR) imaging. In both cases, pMR imaging results demonstrated a massive decrease in signal intensity and an elevated regional cerebral blood volume (rCBV) in the tumor region; however, signal decrease was less prominent and rCBV was lower in healthy brain tissue. In one patient, the rCBV ratio of tumor/brain was 5.0 and the maximal signal decay occurred 3.1 times deeper in the tumor than in the healthy brain tissue. Results of an ultrasonography examination using CH imaging revealed similar data: the tumor/brain ratio for the area under the curve, a parameter corresponding to rCBV, was 4.1. The maximal signal intensity in the tumor was 3.3 times greater than in adjacent healthy brain. Comparable data were obtained in a second patient. Taken together, these findings indicate that CH imaging may be a valuable alternative to pMR imaging. This new, cost-effective bedside ultrasonic technique could be helpful not only as a means of noninvasive staging of gliomas but also as a follow-up imaging modality to evaluate postoperative tumor recurrence or response to antiangiogenic therapy.
Anatomical landmarks for hemispherotomy and their clinical application
Authors: Wen Hung Tzu , Rhoton Albert L. , Marino Raul
Published: May 2009

Object. The authors introduce the surgical concept of the central core of a hemisphere, from which anatomical structures are disconnected during most current hemispherotomy techniques. They also propose key anatomical landmarks for hemispherotomies that can be used to disconnect the hemisphere from its lateral surface around the insula, through the lateral ventricle toward the midline.

Methods. This anatomical study was performed in five adult cadaveric heads following perfusion of the cerebral arteries and veins with colored latex. Anatomical landmarks were used in five hemispheric deafferentations. The central core of a hemisphere consists of extreme, external, and internal capsules; claustrum; lentiform and caudate nuclei; and thalamus. Externally, this core is covered by the insula and surrounded by the fornix, choroid plexus, and lateral ventricle. During most hemispherotomies, the surgeon reaches the lateral ventricle through the frontoparietal opercula or temporal lobe; removes the mesial temporal structures; and disconnects the frontal lobe ahead, the parietal and occipital lobes behind, and the intraventricular fibers of the corpus callosum above the central core. After a temporal lobectomy, the landmarks include the choroid plexus and posterior/ascending portion of the tentorium to disconnect the parietal and occipital lobes, the callosal sulcus or distal anterior cerebral artery (ACA) to sever the intraventricular fibers of the corpus callosum, and the head of the caudate nucleus and ACA to detach the frontal lobe.

Conclusions. These landmarks can be used in any hemispherotomy during which a cerebral hemisphere is disconnected from its lateral surface. Furthermore, they can be used to perform any resection around the central core of the hemisphere and the tentorial incisura.
Transradial approach for neuroendovascular surgery of intracranial vascular lesions
Authors: Eskioglu Eric , Burry Matthew V. , Mericle Robert A.
Published: May 2009

Object. The authors present their experience in performing a transradial approach for neuroendovascular surgery of intracranial vascular lesions when a transfemoral approach was unfavorable.

Methods. Eight patients ranging in age from 52 to 88 years underwent a total of nine neuroendovascular procedures for intracranial vascular lesions. A transradial approach was used in all patients. The patients had previously undergone a transfemoral approach for the endovascular intervention, but that procedure was unsuccessful. Five patients had intracranial basilar artery (BA) aneurysms, one patient had symptomatic BA stenosis, one patient had a dural arteriovenous fistula in the posterior fossa, and one patient had a high-flow arteriovenous malformation in the frontal lobe.

In each case, a transradial approach achieved a stable platform that allowed intracranial microcatheterization for neuroendovascular intervention. None of the patients experienced complications attributed to the transradial artery approach.

Conclusions. During neuroendovascular surgery for the treatment of intracranial lesions, the transradial approach is a viable alternative if the transfemoral approach is unfavorable. This series represents the first known description of neuroendovascular surgery for intracranial lesions via a transradial approach.
Writing-specific sites in frontal areas: a cortical stimulation study
Authors: Lubrano Vincent , Roux Franck-Emmanuel , Démonet Jean-François
Published: May 2009

Object. The aim of this study was to determine whether cortical areas involved in the writing process are associated with reading or naming areas in patients undergoing surgery for brain tumors in frontal areas. This study was undertaken to spare all language areas found in patients during surgery.

Methods. Fourteen patients (eight women and six men [mean age 47 years] of whom 12 were right handed, two left handed, 12 monolingual, and two bilingual) who harbored brain tumors in the left (11 patients) or right (three patients) frontal gyri or in rolandic areas, were tested by direct stimulation by using the awake surgery technique for direct brain mapping. Mapping of the frontal gyri was performed using naming, reading, and writing under dictation tasks in the appropriate language(s).

Considerable individual variability in language organization among patients was observed. Interferences in writing were found during direct stimulation in the frontal gyri, in cortical sites common or not common to interferences in naming or reading. In dominant regions, patterns of writing dysfunctions were variable and included writing arrest, illegible script, letter omissions, and paragraphia. These dysfunctions were nonspecific (stimulation-induced eye movements) in nondominant frontal regions and in rolandic gyri (hand contractions). In the same patient, different writing impairments could sometimes be observed during stimulation of different sites. As is the case for naming or reading interference sites, writing interference sites could be extremely localized (1 cm2 in diameter). In this group of patients, writing interference sites found in Broca areas were associated with other sites of language interference, whereas writing-specific interference sites were found twice in the dominant middle frontal gyrus.

Conclusions. In this series, we found that writing interference sites could be detected by direct cortical stimulation in dominant inferior and middle frontal gyri regardless of whether they were associated with naming or reading interference sites. Writing disorders elicited by direct stimulation in the frontal lobes are varied and probably depend on the functional status of the stimulated cortical area.
Atorvastatin reduction of intravascular thrombosis, increase in cerebral microvascular patency and integrity, and enhancement of spatial learning in rats subjected to traumatic brain injury
Authors: Lu Dunyue , Mahmood Asim , Goussev Anton , Schallert Timothy , Qu Changsheng , Gang Zhang Zheng , Li Yi , Lu Mei , Chopp Michael
Published: May 2009

Object. Atorvastatin, a β-hydroxy-β-methylglutaryl coenzyme A reductase inhibitor, has pleiotropic effects, such as promoting angiogenesis, increasing fibrinolysis, and reducing inflammatory responses, and has shown promise in enhancing recovery in animals with traumatic brain injury (TBI) and stroke. The authors tested the effect of atorvastatin on vascular changes after TBI.

Methods. Male Wistar rats subjected to controlled cortical impact injury were perfused at different time points with fluorescein isothiocyanate (FITC)—conjugated dextran 1 minute before being killed. Spatial memory function had been measured using a Morris Water Maze test at various points before and after TBI. The temporal profile of intravascular thrombosis and vascular changes was measured on brain tissue sections by using a microcomputer imaging device and a laser confocal microscopy. The study revealed the following results. 1) Vessels in the lesion boundary zone and hippocampal CA3 region showed a variety of damage, morphological alterations, reduced perfusion, and intraluminal microthrombin formation. 2) Atorvastatin enhanced FITC—dextran perfusion of vessels and reduced intravascular coagulation. 3) Atorvastatin promoted the restoration of spatial memory function.

Conclusions. These results indicated that atorvastatin warrants investigation as a potential therapeutic drug for TBI.
Atorvastatin reduction of intracranial hematoma volume in rats subjected to controlled cortical impact
Authors: Lu Dunyue , Mahmood Asim , Qu Changsheng , Goussev Anton , Lu Mei , Chopp Michael
Published: May 2009

Object. Atorvastatin, a β-hydroxy-β-methylglutaryl coenzyme A reductase inhibitor, has pleiotropic effects such as improving thrombogenic profile, promoting angiogenesis, and reducing inflammatory responses and has shown promise in enhancing neurological functional improvement and promoting neuroplasticity in animal models of traumatic brain injury (TBI), stroke, and intracranial hemorrhage. The authors tested the effect of atorvastatin on intracranial hematoma after TBI.

Methods. Male Wistar rats were subjected to controlled cortical impact, and atorvastatin (1 mg/kg) was orally administered 1 day after TBI and daily for 7 days thereafter. Rats were killed at 1, 8, and 15 days post-TBI. The temporal profile of intraparenchymal hematoma was measured on brain tissue sections by using a MicroComputer Imaging Device and light microscopy.

Conclusions. Data in this study showed that intraparenchymal and intraventricular hemorrhages are present 1 day after TBI and are absorbed at 15 days after TBI. Furthermore, atorvastatin reduces the volume of intracranial hematoma 8 days after TBI.
Endoscopic anatomy of the chordae willisii in the superior sagittal sinus
Authors: Sharifi Mansoor , Kunicki Jacek , Krajewski Pawel , Ciszek Bogdan
Published: May 2009

Object. Chordae willisii are structures located in the lumen of the superior sagittal sinus (SSS). It is thought that they act as flow-improving structures within the sinuses. There are few anatomical descriptions of chordae willisii, and all previous observations were performed through standard anatomical dissections. The purpose of this study was to visualize and describe structural and topographical features of the chordae willisii with the aid of rigid endoscopy.

Methods. Twenty-five SSSs obtained from fresh human cadavers during autopsies were the material for this study. Specimens were flushed with tap water to remove clots. Bridging veins emptying into the sinus were ligated, and continuous flow of a saline solution through the sinus in a physiological direction was achieved by connecting the sinus to an irrigating system. Rigid endoscopes of different diameters (2.7–4.5 mm) and optic (0 and 30°) were inserted into the lumen of the sinus. The endoscope was connected to a digital camera and a video system to allow for recording of the observed structures. Finally, the sinuses were opened and the chordae willisii were dissected using standard anatomical methods.

The chordae willisii were observed in all examined specimens. Three different types of the cords were found: lamellar, trabecular, and valvelike types. The most common type was the valvelike (mixed) one, which comprised 45.1% of all cords. The chordae willisii were most commonly observed in the parietooccipital region of the SSS.

Conclusions. Witout disturbing any structural relationships, the use of endoscopy allowed visualization and description of intraluminal structures as they behaved physiologically.
Association of an irregularly shaped anterior choroidal aneurysm with CREST syndrome
Authors: Zoumalan Richard A. , Bendok Bernard R. , Parkinson Richard J. , Sorin John , Burke Allan M. , Batjer H. Hunt
Published: May 2009

✓ The authors present the case of a 50-year-old woman with a history of CREST syndrome (calcinosis, Raynaud phenomenon, esophageal motility disorders, sclerodactyly, and telangiectasia), a variant of scleroderma, who was incidentally found to have an irregular intracranial aneurysm.

The patient presented with migraine headaches. A magnetic resonance image of the brain obtained during the headache workup revealed a right posterior carotid artery wall aneurysm in the region of the anterior choroidal artery (AChA). On digital subtraction angiograms, the lesion measured 3.5 mm at its largest diameter.

Because of the irregular shape of the aneurysm, the patient's relatively young age, and the potential for further aneurysm growth due to collagen disease, surgical clip application was recommended following a discussion of available treatment options. At surgery, the aneurysm was identified as bilobed and broad based, and the AChA was found to be associated with the aneurysm neck. Satisfactory clipping of the aneurysm was achieved with preservation of the parent vessels.

An association of CREST syndrome with intracranial aneurysms has only been reported once before. This case is presented to draw attention to the possibility of a pathophysiological connection between CREST syndrome and intracranial aneurysms and to postulate a possible mechanism whereby this condition may result in aneurysm formation. The association of aneurysms with other pathological collagen-related conditions is well known, and literature relevant to a possible connection between CREST syndrome and aneurysms is reviewed and discussed.
Monitoring of the lateral spread response in the endovascular treatment of a hemifacial spasm caused by an unruptured vertebral artery aneurysm
Authors: Murakami Hiroatsu , Kawaguchi Tadashi , Fukuda Masafumi , Ito Yasushi , Hasegawa Hitoshi , Tanaka Ryuichi
Published: May 2009

✓ The lateral spread response (LSR) is used in the electrophysiological diagnosis of a hemifacial spasm or for monitoring during microvascular decompression. The authors used LSRs for intraoperative monitoring during endovascular surgery in a rare case of vertebral artery (VA) aneurysm that caused intractable hemifacial spasm.

A 49-year-old woman presented with a right hemifacial spasm that had persisted for 9 months. No other clinical symptom was observed. Vertebral artery angiography revealed a saccular aneurysm of the right VA. Magnetic resonance (MR) imaging demonstrated that the aneurysm was compressing the root exit zone of the right facial nerve. Endovascular treatment of the VA aneurysm was performed while monitoring the patient's LSRs. During occlusion of the VA at sites distal and proximal to the aneurysm, the LSRs temporarily disappeared and then reappeared with a higher amplitude than those measured preceding their disappearance. The hemifacial spasm alleviated gradually and disappeared completely 6 months after treatment. The LSRs changed in parallel with the improvement in the patient's hemifacial spasms and eventually disappeared. No recurrence of symptoms has been noticed as of 18 months postoperatively.

This is the first report of the use of LSR monitoring during endovascular surgery for an intracranial aneurysm that causes hemifacial spasm. Intraoperative and postoperative changes in the LSRs provided useful information regarding the pathophysiology of hemifacial spasm.
Preoperative stent placement for intradural vertebral artery stenosis from a rare xanthogranuloma
Authors: Boulos Alan S. , Deshaies Eric M. , Qian Jiang , Popp A. John
Published: May 2009

✓ In this report, the authors discuss a novel use of intradural vertebral artery (VA) stent placement to protect a tumor-encased vessel from injury during lesion resection. The tumor was a rare foramen magnum region xanthogranuloma and a component of Erdheim—Chester disease (ECD). This 64-year-old man presented with large masses encasing and compressing the intracranial segments of each VA. Preoperatively, a left VA stent was placed to protect the arterial wall during resection of the tumor. Histopathological study results on the subtotally resected mass were consistent with xanthogranuloma, a rare benign histiocytic tumor frequently occurring in patients with ECD. Further radiographic evaluation in the patient revealed an osteolytic lesion of the eleventh thoracic vertebra supporting the diagnosis of ECD disease. Based on this case study, the authors recommend the following: 1) tumor-encased vessels can be protected preoperatively by stent placement to assist with tumor debulking; and 2) patients diagnosed with a xanthogranuloma should be evaluated for multisystem involvement consistent with ECD.
Resolution of pseudotumor cerebri after bariatric surgery for related obesity
Authors: Nadkarni Trimurti , Rekate Harold L. , Wallace Donna
Published: May 2009

✓ Two obese women, both of whom were 42 years of age, were examined for pseudotumor cerebri. Intracranial venography revealed increased pressure in the dural venous sinuses and the right atrium. The increased right atrial pressure was attributable to the patients' obesity. Both patients underwent bariatric surgery to achieve weight loss. Approximately 1 year later, a clinical evaluation showed that in both women the pseudotumor cerebri had resolved. Repeated measurements of dural venous pressure indicated that the patients' pressures had returned to normal. Obese patients with pseudotumor cerebri and stable visual symptoms are best treated with weight loss to avoid shunt placement or optic nerve sheath fenestration.
Cost of treating high-risk symptomatic carotid artery stenosis: stent insertion and angioplasty compared with endarterectomy
Authors: Ecker Robert D. , Brown Robert D. , Nichols Douglas A. , McClelland Robyn L. , Reinalda Megan S. , Piepgras David G. , Cloft Harry J. , Kallmes David F.
Published: May 2009

Object. Definitive data characterizing the safety and efficacy of carotid angioplasty with stent placement (CAS) for symptomatic, occlusive carotid artery (CA) disease require further refinements and standardization of techniques as well as large prospective studies on a par with the North American Symptomatic Carotid Endarterectomy Trial (NASCET). Despite the absence of such data, many surgeons have performed angioplasty and stent placement in patients with clinical or anatomical features known to add significant perioperative risk and capable of disqualifying the patients from participation in NASCET. There exists no cost analysis comparing high-risk endarterectomy with percutaneous angioplasty and stent insertion.

Methods. Forty-five patients (29 men and 16 women) with high-risk, symptomatic CA stenosis have been treated with CAS at the authors' institution since 1996. Indications for this procedure included symptomatic recurrent stenosis following CA endarterectomy (CEA), active coronary disease, high CA bifurcation, and severe medical comorbidities. A long-standing CEA computer database was screened for control patients with similar risk factors; 391 patients (276 men and 115 women) were identified. Actual cost data, duration of hospital stay, and relevant clinical data from the time of treatment until hospital discharge were collected in each patient. The median total cost of CAS was $10,628, whereas that for CEA was $10,148 (p = 0.495).

Conclusions. In patients with high-risk, NASCET-ineligible CA stenosis there was no overall statistically significant cost difference between CEA and CAS. Given that there may not be a cost advantage for either procedure, procedural risk, efficacy, and durability should be key factors in determining the optimal treatment strategy.
Dotlike hemosiderin spots on T2*-weighted magnetic resonance imaging as a predictor of stroke recurrence: a prospective study
Authors: Imaizumi Toshio , Horita Yoshifumi , Hashimoto Yuji , Niwa Jun
Published: May 2009

Object. Microangiopathy associated with hypertension is a notable cause of cerebral small vessel disease (SVD), including deep intracerebral hemorrhage (ICH) and lacunar infarct. Dotlike low-intensity spots (dotlike hemosiderin spots: dotHSs) on T2*-weighted magnetic resonance (MR) images have been histologically diagnosed as old cerebral microbleeds associated with lipohyalinosis, amyloid angiopathy, or other microangiopathies and located in deep or subcortical regions. The aim of this study was to determine whether dotHSs indicate the severity of microangiopathy, and if so, whether large numbers of deep dotHSs are associated with SVD recurrence.

Methods. The authors prospectively analyzed the number of dotHSs in 337 patients—191 men and 146 women with a mean age of 66 ± 10.4 years (range 37–94 years)—with SVD (199 ICHs and 138 lacunar infarcts) who had been consecutively admitted to Hakodate Municipal Hospital. The follow-up period was 3.5 to 42 months (22.5 ± 13.1 months). Patients were divided into two groups based on the recurrence. The hazard ratio (HR) for recurrence was estimated based on the Cox proportional hazard model by using the number of deep and subcortical dotHSs as well as other factors. Of 337 patients, 20 were readmitted with recurrence. Results of a multivariate analysis revealed an elevated rate of recurrence in patients with many subcortical dotHSs (≥ 5, HR 4.36, p = 0.0019) or a history of ICH (HR 3.82, p = 0.014). A trend toward a positive correlation (Pearson correlation coefficient 0.548, p < 0.0001) was found between the number of deep and subcortical dotHSs.

Conclusions. Although a small sample size limited the power of analyses, the findings indicate that a large number of subcortical dotHSs may predict SVD recurrence.
Gliomas following organ transplantation: analysis of the contents of a tumor registry
Authors: Schiff David
Published: May 2009

Object. The author and others have described a series of patients in whom gliomas have developed following solid organ transplantation. Additionally, patients infected with human immunodeficiency virus reportedly have an increased incidence of gliomas. The author sought to examine the association between the immunosuppressive state in organ transplant recipients and the development of gliomas.

Methods. Reported cases of tumor in the transplant population of the Israel Penn International Transplant Tumor Registry (IPITTR) were examined. These cases were compared with predicted cases in the 2001 American Cancer Society (ACS) estimates.

Of the 7256 malignant tumors listed in the IPITTR database, 19 (0.3%) were primary brain tumors, including 14 gliomas. Tumors known to occur at an increased frequency in transplant recipients accounted for a 1.6- to 2.9-fold increased percentage of cases in the IPITTR compared with 2001 ACS estimates. Tumors not thought to occur with an increased frequency in this population, such as gastrointestinal malignancy and lung cancer, had ratios of 0.19 to 0.35. The corresponding ratio for primary brain tumors was 0.19. None of the six cases previously described by the author and his colleagues was reported to the IPITTR.

Conclusions. Primary brain tumors, including gliomas, do not appear to be overrepresented in the IPITTR, indicating that they may not arise with increased frequency in transplant recipients. Nevertheless, one cannot exclude the possibility that neurooncologists may have underreported such cases to this voluntary tumor registry.
Cerebrospinal fluid pulse pressure method: a possible substitute for the examination of B waves
Authors: Lenfeldt Niklas , Andersson Nina , Ågren-Wilsson Aina , Bergenheim A. Tommy , Koskinen Lars-Owe D. , Eklund Anders , Malm Jan
Published: May 2009

Object. The appearance of numerous B waves during intracranial pressure (ICP) registration in patients with idiopathic adult hydrocephalus syndrome (IAHS) is considered to predict good outcome after shunt surgery. The aim of this study was to describe which physical parameters of the cerebrospinal fluid (CSF) system B-waves reflect and to find a method that could replace long-term B-wave analysis.

Methods. Ten patients with IAHS were subjected to long-term registration of ICP and a lumbar constant-pressure infusion test. The B-wave presence, CSF outflow resistance (Rout), and relative pulse pressure coefficient (RPPC) were assessed using computerized analysis. The RPPC was introduced as a parameter reflecting the joint effect of elastance and pulsatory volume changes on ICP and was determined by relating ICP pulse amplitudes to mean ICP.

Conclusions. The B-wave presence on ICP registration correlates strongly with RPPC (r = 0.91, p < 0.001, 10 patients) but not with CSF Rout. This correlation indicates that B waves—like RPPC—primarily reflect the ability of the CSF system to reallocate and store liquid rather than absorb it. The RPPC-assessing lumbar short-term CSF pulse pressure method could replace the intracranial long-term B-wave analysis.
Surgical management of meningiomas involving the optic nerve sheath
Authors: Schick Uta , Dott Uwe , Hassler Werner
Published: May 2009

Object. The management of optic nerve sheath meningiomas (ONSMs) remains controversial but includes surgery, radiotherapy, and plain observation. Surgery is often thought to result in postoperative blindness. The authors report on a large series of patients surgically treated for ONSM, with an emphasis on the visual outcome.

Methods. Seventy-three patients with ONSMs who had undergone surgery between 1991 and 2002 were retrospectively analyzed. The standard surgical approach consisted of pterional craniotomy, intradural (54 patients) or extradural (10 patients) unroofing of the optic canal, or a combined procedure (seven patients). Thirty-two tumors demonstrated extension through the optic canal. Twenty-nine tumors reached the chiasm or contralateral side.

Patients with intraorbital flat tumors should undergo radiotherapy instead of surgery. Those with a large intraorbital mass and no useful vision should undergo surgery. Tumors extending intracranially through the optic canal are amenable to decompression of the optic canal and resection of the intracranial portion.

The follow-up period was a mean 45.4 months (range 6–144 months). Ten patients underwent postoperative radiotherapy. Visual acuity was not significantly influenced by surgery but did become worse with a longer duration of preoperative symptoms and a longer follow-up period. A tumor location in the optic canal was another negative factor. Radiotherapy preserved vision in five of 10 cases.

Conclusions. The loss of vision in patients with ONSM is only a matter of time. In patients with good vision the role of radiotherapy becomes more important. Surgery is recommended for intracranial tumors to prevent contralateral extension.
Stereotactic biopsy guidance in adults with supratentorial nonenhancing gliomas: role of perfusion-weighted magnetic resonance imaging
Authors: Maia Antonio C. M. , Malheiros Suzana M. F. , da Rocha Antonio J. , Stávale João N. , Guimarães Iara F. , Borges Lia R. R. , Santos Adrialdo J. , da Silva Carlos J. , de Melo Julieta G. S. P. , Lanzoni Oreste P. , Gabbai Alberto A. , Ferraz Fernando A. P.
Published: May 2009

Object. The diagnosis of low-grade glioma (LGG) cannot be based exclusively on conventional magnetic resonance (MR) imaging studies, and target selection for stereotactic biopsy is a crucial issue given the high risk of sampling errors. The authors hypothesized that perfusion-weighted imaging could provide information on the microcirculation in presumed supratentorial LGGs.

Methods. All adult patients with suspected (nonenhancing) supratentorial LGGs on conventional MR imaging between February 2001 and February 2004 were included in this study. Preoperative MR imaging was performed using a dynamic first-pass gadopentate dimeglumine—enhanced spin echo—echo planar perfusion-weighted sequence, and the tumors' relative cerebral blood volume (rCBV) measurements were expressed in relation to the values observed in contralateral white matter. In patients with heterogeneous tumors a stereotactic biopsy was performed in the higher perfusion areas before resection.

Among 21 patients (16 men and five women with a mean age of 36 years, range 23–60 years), 10 had diffuse astrocytomas (World Health Organization Grade II) and 11 had other LGGs and anaplastic gliomas. On perfusion-weighted images demonstrating heterogeneous tumors, areas of higher rCBV focus were found to be oligodendrogliomas or anaplastic astrocytomas on stereotactic biopsy; during tumor resection, however, specimens were characterized predominantly as astrocytomas. Diffuse astrocytomas were associated with significantly lower mean rCBV values compared with those in the other two lesion groups (p < 0.01). The rCBV ratio cutoff value that permitted better discrimination between diffuse astrocytomas and the other lesion groups was 1.2 (80% sensitivity and 100% specificity).

Conclusions. Perfusion-weighted imaging is a feasible method of reducing the sampling error in the histopathological diagnosis of a presumed LGG, particularly by improving the selection of targets for stereotactic biopsy.
Simultaneous microscopic and endoscopic monitoring during surgery for internal carotid artery aneurysms
Authors: Kinouchi Hiroyuki , Yanagisawa Toshiharu , Suzuki Akira , Ohta Tohru , Hirano Yoshitaka , Sugawara Taku , Sasajima Toshio , Mizoi Kazuo
Published: May 2009

Object. The authors of this study evaluated the efficacy of simultaneous microscopic and endoscopic monitoring during surgery for internal carotid artery (ICA) aneurysms.

Methods. The endoscopic technique was applied during microsurgery in 11 patients with 13 aneurysms. Nine of these lesions were located on the posterior communicating artery (PCoA), three in the paraclinoid region, and one on the anterior choroidal artery (AChA). Eight patients had unruptured aneurysms and three had ruptured aneurysms. The endoscope was introduced after first exposing the aneurysm through the microscope and was gripped firmly by an air-locked holding arm fitted with a steering system throughout the entire surgery, including dissection of the perforating arteries and application of the aneurysm clips.

Regarding paraclinoid aneurysms, clips were applied through direct visualization of the ophthalmic artery and the proximal neck. In a case involving a superior hypophyseal artery aneurysm in the paraclinoid segment, a ring clip was applied without removing the bone structure around the optic canal. In all aneurysms of the PCoA and the AChA, perforating arteries behind the lesion were identified and dissected using endoscopic control. The aneurysm clip was applied in the best position in a single attempt in 10 of 11 patients. There was no surgical complication related to the endoscopic procedures.

Conclusions. Simultaneous monitoring with the microscope and endoscope is extremely useful in applying clips to ICA aneurysms. This combined method allows for direct dissection of the aneurysm, perforating vessels, and the main trunk in an area not visible through the microscope's eyepiece and promises better surgical results.
Aurora-B dysfunction of multinucleated giant cells in glioma detected by site-specific phosphorylated antibodies
Authors: Fujita Mitsugu , Mizuno Masaaki , Nagasaka Tetsuro , Wakabayashi Toshihiko , Maeda Kenkou , Ishii Dai , Arima Toru , Kawajiri Aie , Inagaki Masaki , Yoshida Jun
Published: May 2009

Object. The origin of multinucleated giant cells in glioma has not been made clear. In a previous paper the authors studied multinucleated giant tumor cells by using mitosis-specific phosphorylated antibodies to determine the phosphorylation of intermediate filaments and demonstrated that these cells stay in the early mitotic stage, undergoing neither fusion nor degeneration. In the current study the authors investigated the possible genetic causes of multinucleated giant tumor cells.

Methods. Cultured mono- or multinucleated human glioma cells were immunostained with monoclonal antibodies (mAbs) 4A4, YT33, TM71, HTA28, YG72, and αAIM-1. The three former antibodies revealed a particular mitotic cell cycle through site-specific phosphorylation of vimentin; that is, the early phase, mid phase, and late phase, respectively. The three later antibodies demonstrated phosphorylation of H3 at Ser28, phosphorylation of vimentin at Ser72, and aurora-B, respectively, making it possible to identify aurora-B distribution and function during mitosis. In addition, paraffin-embedded tissue sections obtained in three patients with giant cell glioblastoma were also examined.

Multinucleated giant tumor cells immunoreacted with the mAb 4A4 and αAIM-1 but not with YT33, TM71, HTA28, and YG72 in vitro and in vivo.

Conclusions. Findings in this study indicated that multinucleated giant tumor cells remain in the early mitotic phase because of aurora-B dysfunction, effecting aberrations in cytoplasmic cleavage without affecting nuclear division.
Detection of soluble intercellular adhesion molecule—1 and vascular cell adhesion molecule—1 in both cerebrospinal fluid and serum of patients after aneurysmal subarachnoid hemorrhage
Authors: Kaynar Mehmet Yasar , Tanriverdi Taner , Kafadar Ali Metin , Kacira Tibet , Uzun Hafize , Aydin Seval , Gumustas Koray , Dirican Ahmet , Kuday Cengiz
Published: May 2009

Object.The aim of this study was to explore whether levels of intercellular adhesion molecule—1 (ICAM-1) and vascular cell adhesion molecule—1 (VCAM-1) are elevated in the cerebrospinal fluid (CSF) and serum of patients after aneurysmal subarachnoid hemorrhage (SAH).

Methods.This prospective clinical study focused on 21 patients who had recently suffered an SAH due to aneurysmal rupture and 15 control patients with hydrocephalus who had no other central nervous system disease. Cerebrospinal fluid and serum samples obtained within the first 3 days and on the 5th and 7th days of SAH were assayed for ICAM-1 and VCAM-1 by using quantitative enzyme-linked immunosorbent assays.

Levels of soluble forms of ICAM-1 (p = 0.00001) and VCAM-1 (p = 0.009) in the patients' CSF and those of ICAM-1 (p = 0.00001) and VCAM-1 (p = 0.00001) in their serum were found to be elevated after SAH compared with levels in the CSF and serum of control patients with hydrocephalus. In addition, when the authors compared the increased levels of adhesion molecules in the CSF and serum of patients after SAH, the only statistically insignificant difference that they found was between the levels of VCAM-1 in serum obtained on Days 5 and 7 after SAH (p = 0.27).

Conclusions.Adhesion molecules are a group of macromolecules that may participate in the inflammatory process, a common pathway leading to vasospasm after SAH. Leukocyte adherence to the vascular endothelium, which is induced by adhesion molecules, has been believed to be the initial signal of the development of vasospasm. The authors have demonstrated the synchronized elevation of two adhesion molecules in both CSF and serum following aneurysmal SAH. Blocking of ICAM-1 as well as VCAM-1 by monoclonal antibodies post-SAH may provide a beneficial effect on vasospasm.