bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of glial filaments in cells and tumors of glial origin: a review
Authors: Rutka James T. , Murakami Masaji , Dirks Peter B. , Hubbard Sherri Lynn , Becker Laurence E. , Fukuyama Kozo , Jung Shin , Matsuzawa Kazuhito
Published: January 2008

In the adult human brain, normal astrocytes constitute nearly 40% of the total central nervous system (CNS) cell population and may assume a star-shaped configuration resembling epithelial cells insofar as the astrocytes remain intimately associated, through their cytoplasmic extensions, with the basement membrane of the capillary endothelial cells and the basal lamina of the glial limitans externa. Although their exact function remains unknown, in the past, astrocytes were thought to subserve an important supportive role for neurons, providing a favorable ionic environment, modulating extracellular levels of neurotransmitters, and serving as spacers that organize neurons. In immunohistochemical preparations, normal, reactive, and neoplastic astrocytes may be positively identified and distinguished from other CNS cell types by the expression of the astrocyte-specific intermediate filament glial fibrillary acidic protein (GFAP). This GFAP is a 50-kD intracytoplasmic filamentous protein that constitutes a portion of, and is specific for, the cytoskeleton of the astrocyte. This protein has proved to be the most specific marker for cells of astrocytic origin under normal and pathological conditions. Interestingly, with increasing astrocytic malignancy, there is progressive loss of GFAP production. As the human gene for GFAP has now been cloned and sequenced, this review begins with a summary of the molecular biology of GFAP including the proven utility of the GFAP promoter in targeting genes of interest to the CNS in transgenic animals. Based on the data provided the authors argue cogently for an expanded role of GFAP in complex cellular events such as cytoskeletal reorganization, maintenance of myelination, cell adhesion, and signaling pathways. As such, GFAP may not represent a mere mechanical integrator of cellular space, as has been previously thought. Rather, GFAP may provide docking sites for important kinases that recognize key cellular substrates that enable GFAP to form a dynamic continuum with microfilaments, integrin receptors, and the extracellular matrix.
Two-portal endoscopic carpal tunnel release surgery: report of early experience
Authors: Piccirilli Cynthia B. , Shaffrey Christopher I. , Young Jacob N. , Lovell LaVerne R.
Published: January 2008

Endoscopic carpal tunnel release is increasingly performed to treat median nerve entrapment neuropathy at the transverse carpal ligament. Proponents of these procedures claim that there are early postoperative advantages to be gained by the patient in the form of decreased pain and weakness, thus facilitating an earlier return to function. However, serious complications associated with the use of these techniques have been reported, especially during the surgeon's purported initial steep learning curve. A prospective analysis of the authors' first 51 cases using a two-portal endoscopic technique was conducted to determine whether these learning curve complications occurred. The authors did experience a learning curve; however, it was not significant. They encountered no serious complications and patient satisfaction was very high. It is concluded that the procedure is relatively easy to learn and safe to perform.
Surgical management of lumbar stenosis: decompression and indications for fusion
Authors: Epstein Nancy E.
Published: January 2008

Review of the clinical, neuroradiological, and surgical management of lumbar spinal stenosis reveals that 90 to 95% of congenital or acquired variants may be adequately managed by means of decompression without fusion. These decompressive procedures often simultaneously treat disc herniations, limbus fractures, degenerative spondylolisthesis, rare selected cases of spondylolisthesis accompanied by lysis in older patients, and degenerative scoliosis. Fusion should be reserved for the approximately 5 to 10% of patients in whom there is clinical evidence of instability prior to surgery or for the few who develop slippage following laminectomy and facetectomy.
The impact of p53 tumor suppressor gene on glioma biology
Authors: Litofsky N. Scott , Recht Lawrence D.
Published: January 2008

The tumor suppressor gene, p53, is important in glioma biology. The authors of this paper review its role in cell physiology, epidemiology, glioma progression, prognosis, and therapeutic advances.
Attenuation of vasospasm and hemoglobin-induced constriction in the rabbit basilar artery by a novel protease inhibitor
Authors: Cappelletto Barbara , Caner Hakan H. , Schottler Frank , Kwan Aij-Lie , Eveleth David , Foley Patricia L. , Kassell Neal F. , Lee Kevin S.
Published: January 2008

Calcium-activated proteolysis mediated by the protease inhibitor, calpain, has recently been implicated in the pathogenesis of cerebral vasospasm. The effect of one inhibitor of calcium-activated proteolysis, z-Leu-Phe-CONH-morpholene (zLF), on cerebrovascular constriction was examined in two experimental paradigms. In the first paradigm, the rabbit basilar artery (BA) was visualized via a transclival exposure, and its diameter was monitored using videomicroscopy. In the second experimental paradigm two intracisternal injections of autologous blood were administered to mimic a subarachnoid hemorrhage (SAH). The BA was visualized via the transclival exposure, and its luminal diameter was measured. Topical application of oxyhemoglobin (OxyHb), a known pathogenic agent in cerebral vasospasm, elicited vasoconstriction in normal animals, reducing arterial diameter to approximately 75% of resting levels. Pretreatment with zLF (100, 200, or 300 μM) attenuated vasoconstriction induced by OxyHb. In an experimental model of SAH, the diameter of the BA was reduced after the first injection of blood to approximately 67% of normal resting levels when measured 3 to 4 days later. This vasospastic response was reversed significantly by topical application of zLF (100 μM); vascular diameter was increased to approximately 84% of normal resting levels.

These findings demonstrate that both acute OxyHb-induced constriction and blood-induced vasospasm are sensitive to an inhibitor of the proteolytic enzyme, calpain. Together, these observations indicate an important role for calcium-activated proteolysis in the development and maintenance of vasospasm after SAH. In addition, it may be inferred from the data that inhibitors of calcium-activated proteolysis may be useful therapeutic agents for treating this form of cerebrovascular disease.
Split spinal cord malformations in children
Authors: Ersahin Yusuf , Mutluer Saffet , Kocaman Sevgül , Demirtas Eren
Published: January 2008

The authors reviewed and analyzed information on 74 patients with split spinal cord malformations (SSCMs) treated between January 1, 1980 and December 31, 1996 at their institution with the aim of defining and classifying the malformations according to the method of Pang, et al.

Computerized tomography myelography was superior to other radiological tools in defining the type of SSCM. There were 46 girls (62%) and 28 boys (38%) ranging in age from less than 1 day to 12 years (mean 33.08 months). The mean age (43.2 months) of the patients who exhibited neurological deficits and orthopedic deformities was significantly older than those (8.2 months) without deficits (p = 0.003). Fifty-two patients had a single Type I and 18 patients a single Type II SSCM; four patients had composite SSCMs. Sixty-two patients had at least one associated spinal lesion that could lead to spinal cord tethering. After surgery, the majority of the patients remained stable and clinical improvement was observed in 18 patients.

The classification of SSCMs proposed by Pang, et al., will eliminate the current chaos in terminology. In all SSCMs, either a rigid or a fibrous septum was found to transfix the spinal cord. There was at least one unrelated lesion that caused tethering of the spinal cord in 85% of the patients. The risk of neurological deficits resulting from SSCMs increases with the age of the patient; therefore, all patients should be surgically treated when diagnosed, especially before the development of orthopedic and neurological manifestations.
Transfection of C6 glioma cells with the bax gene and increased sensitivity to treatment with cytosine arabinoside
Authors: Vogelbaum Michael A. , Tong Jianxin X. , Higashikubo Ryuji , Gutmann David H. , Rich Keith M.
Published: January 2008

Genes known to be involved in the regulation of apoptosis include members of the bcl-2 gene family, such as inhibitors of apoptosis (bcl-2 and bcl-xl) and promotors of apoptosis (bax). The authors investigated a potential approach for the treatment of malignant gliomas by using a gene transfection technique to manipulate the level of an intracellular protein involved in the control of apoptosis.

The authors transfected the murine bax gene, which had been cloned into a mammalian expression vector, into the C6 rat glioma cell line. Overexpression of the bax gene resulted in a decreased growth rate (average doubling time of 32.96 hours compared with 22.49 hours for untransfected C6, and 23.11 hours for clones transfected with pcDNA3 only), which may be caused, in part, by an increased rate of spontaneous apoptosis (0.77 ± 0.15% compared with 0.42 ± 0.08% for the vector-only transfected C6 cell line; p = 0.038, two-tailed Student's t-test). Treatment with 1 μM of cytosine arabinoside (ara-C) resulted in significantly more cells undergoing apoptosis in the cell line overexpressing bax than in the vector-only control cell line (23.57 ± 2.6% compared with 5.3 ± 0.7% terminal deoxynucleotidyl transferase-mediated biotinylated-deoxyuridine triphosphate nick-end labeling technique-positive cells; p = 0.007). Furthermore, measurements of growth curves obtained immediately after treatment with 0.5 μM ara-C demonstrated a prolonged growth arrest of at least 6 days in the cell line overexpressing bax.

These results can be used collectively to argue that overexpression of bax results in increased sensitivity of C6 cells to ara-C and that increasing bax expression may be a useful strategy, in general, for increasing the sensitivity of gliomas to antineoplastic treatments.
Comparison of functional outcomes from orthopedic and neurosurgical interventions in spastic diplegia
Authors: Abel Mark F. , Damiano Diane L. , McLaughlin John F. , Song Kit M. , Graubert Catherine S. , Bjornson Kristie F.
Published: January 2008

Selective dorsal rhizotomy (SDR) and orthopedic surgery, in the form of muscle-tendon (MT) lengthening surgery are commonly performed in ambulatory children with spastic diplegia to improve their level of motor function. This investigation is a post hoc comparison of the functional effects from each of these surgical options in 30 patients with spastic diplegia who underwent one of these interventions as their initial surgical procedure. Sixteen children underwent SDR and 14 underwent MT surgery in two separate prospective clinical trials. The same functional outcome measures preoperatively and approximately 1 year postoperatively were used in both studies including temporospatial parameters from three-dimensional gait analysis, the total score, and score on each of the five dimensions of the Gross Motor Function Measure (GMFM). Comparisons indicate that patients who underwent SDR had significant improvements in GMFM Dimensions 2, 4, and 5 as well as in total score, although 63% of those studied had a 10% or more reduction in gait velocity. Gait was more predictably improved in the MT group, with only 21% demonstrating reductions in velocity. Conversely, the change in GMFM scores in the MT group was not as pervasive and skewed toward higher skills with only GMFM Dimension 5 and total score improved significantly. Several important hypotheses are derived from these comparisons. Multicenter clinical trials are needed to define more clearly the indications for and to assess more comprehensively the outcomes from each intervention.
Thoracoscopic microsurgical excision of a thoracic schwannoma
Authors: Dickman Curtis A. , Apfelbaum Ronald I.
Published: January 2008

A 6-cm-diameter schwannoma located at T-2 was resected completely by using transthoracic microsurgical endoscopy. The partially cystic tumor widened the neural foramen and extended into the apex of the right thoracic cavity but did not extend intradurally. The tumor was accessed by means of three 15-mm incisions made in the intercostal spaces. The operative blood loss was only 200 ml, and there were no complications. The patient was discharged on the 2nd postoperative day and returned to full activity 1 week after surgery.

Thoracoscopy provides an excellent alternative to thoracotomy for peripheral thoracic nerve sheath tumors that originate within the neural foramen or more distally along the intercostal nerves within the thorax. An anterior approach is required for intrathoracic tumors but is not suited for intradural tumors. An open posterior or posterolateral approach to the thoracic spine is required for intradural tumors to allow the dura to be closed adequately.
Selective intraarterial gene delivery into a canine meningioma
Authors: Chauvet Anne E. , Kesava Prabhakar P. , Goh Chern Sing , Badie Behnam
Published: January 2008

Object

The goal of this study was to evaluate gene delivery to a benign brain tumor.

Methods

A recombinant adenovirus vector bearing the Escherichia coli ß-galactosidase reporter gene was selectively injected into the vascular supply of a spontaneously occurring canine olfactory groove meningioma. The tumor and a small amount of peritumoral brain tissue were removed 5 days after viral injection and stained with X-Gal to assess gene delivery. The authors noted significant ß-galactosidase gene expression by the tumor, but not by surrounding brain tissue. No obvious viral-related cytotoxicity was noted.

Conclusions

The authors found that meningiomas can be successfully transduced by adenovirus vectors by using endovascular techniques.
Relationship between cerebral blood flow and the development of swelling and life-threatening herniation in acute ischemic stroke
Authors: Firlik Andrew D. , Yonas Howard , Kaufmann Anthony M. , Wechsler Lawrence R. , Jungreis Charles A. , Fukui Melanie B. , Williams Robert L.
Published: January 2008

Object

The purpose of this study was to determine whether cerebral blood flow (CBF) measurements in acute stroke could be correlated with the subsequent development of cerebral edema and life-threatening brain herniation.

Methods

Twenty patients with aggressively managed acute middle cerebral artery (MCA) territory strokes who underwent xenon-enhanced computerized tomography (Xe-CT) CBF scanning within 6 hours of onset of symptoms were retrospectively reviewed. The relationship among CBF and follow-up CT evidence of edema and clinical evidence of brain herniation during the 36 to 96 hours following stroke onset was analyzed.

Initial CT scans displayed abnormal findings in 11 patients (55%), whereas the Xe-CT CBF scans showed abnormal findings in all patients (100%). The mean CBF in the symptomatic MCA territory was 10.4 ml/100 g/minute in patients who developed severe edema compared with 19 ml/100 g/minute in patients who developed mild edema (p < 0.05). The mean CBF in the symptomatic MCA territory was 8.6 ml/100 g/minute in patients who developed clinical brain herniation compared with 18 ml/100 g/minute in those who did not (p < 0.01). The mean CBF in the symptomatic MCA territory that was 15 ml/100 g/minute or lower was significantly associated with the development of severe edema and herniation (p < 0.05).

Conclusions

Within 6 hours of acute MCA territory stroke, Xe-CT CBF measurements can be used to predict the subsequent development of severe edema and progression to clinical life-threatening brain herniation. Early knowledge of the anatomical and clinical sequelae of stroke in the acute phase may aid in the triage of such patients and alert physicians to the potential need for more aggressive medical or neurosurgical intervention.
Outcomes in patients treated with gamma knife radiosurgery for brain metastases from malignant melanoma
Authors: Friehs Gerhard M. , Legat Joseph , Zheng Zhen , Pendl Gerhard , Noren Georg C.
Published: January 2008

In order to determine the effectiveness of gamma knife (GK) radiosurgery in patients with malignant melanoma metastases, the authors conducted a prospective multicenter study. :Forty-five patients with a total of 96 lesions were treated and followed to measure survival time, tumor control rate, and Karnofsky Performance Scale (KPS) score. The mean survival time was 8.7 months (median 4.2 months), and tumor control was achieved in 86% of lesions. When obtained, the median preoperative KPS of 80 was maintained at a median of 80 post-GK treatment.

The authors found GK treatment for metastases of malignant melanoma to be highly effective in controlling tumor growth. Survival rates obtained after GK treatment were found to be superior to historically obtained data concerning external beam radiotherapy follow up. Radiosurgery with the GK can therefore be considered a good primary treatment option for metastatic brain disease of malignant melanoma.
Combined chemotherapy and radiation therapy for central nervous system germ cell tumors: preliminary results of a Phase II study of the Japanese Pediatric Brain Tumor Study Group
Authors: Matsutani Masao , Ushio Yukitaka , Abe Hiroshi , Yamashita Junko , Shibui Soichiro , Fujimaki Takamitsu , Takakura Kintomo , Nomura Kazuhiro , Tanaka Ryuichi , Fukui Masashi , Yoshimoto Takashi , Hayakawa Toru , Nagashima Tadashi , Kurisu Kaoru , Kayama Takamasa , _ _
Published: January 2008

The authors conducted a multiinstitutional phase II study to establish a postsurgical combined chemotherapy and radiation therapy regimen for patients with primary germ cell tumors of the brain.

After surgical debulking of the tumor and histological verification, patients were divided into three therapeutic groups: good prognosis, intermediate prognosis, and poor prognosis. Patients received two kinds of chemotherapy (three courses) prior to receiving radiation therapy: carboplatin-etoposide combination ([CARB-VP]: carboplatin 450 mg/m2 on Day 1, etoposide 150 mg/m2 on Days 1-3) or ifosphamide-cisplatin-etoposide combination ([ICE]: ifosphamide 900 mg/m2, cisplatin 20 mg/m2, and etoposide 60 mg/m2 on Days 1-5). Patients in the good prognosis group (those with germinomas) were treated with CARB-VP followed by local radiation therapy (24 Gy). Patients in the intermediate prognosis group received CARB-VP followed by local radiation therapy (50 Gy); they received five additional chemotherapy treatments. Patients in the poor prognosis group received ICE followed by whole craniospinal radiation therapy; they also received five additional chemotherapy treatments. Eighty-two patients were evaluated. For the 56 patients with germinomas, a 93% rate of complete remission after treatment was achieved. The remission rate was 76% for 21 patients in the intermediate prognosis group, and no recurrence was detected during a median follow-up period of 2.6 years. In the group of five patients with poor prognosis, the disease in three patients progressed during chemotherapy or radiation therapy and they died within 6 months. There were no serious complications in the surviving patients.

The authors found their treatment protocols to be currently effective for patients with germinomas and those with an intermediate prognosis.
High-resolution T2-reversed magnetic resonance imaging on a high-magnetic field system
Authors: Fujii Yukihiko , Nakayama Naoki , Nakada Tsutomu
Published: January 2008

Because of the high signal-to-noise (S/N) ratio, T2-weighted images obtained using high-field magnetic resonance (MR) imaging systems can be expected to provide high anatomical and contrast resolution. Furthermore, the improved structural and contrast resolution of these high S/N T2-weighted images can be processed for optimum perceptual resolution through the application of gray-scale reversal and expansion of the gray-scale window, known as T2-reversed (T2R) imaging. In this study, the authors investigated high-resolution T2R MR imaging performed on a high-field (3-tesla) system for its clinical utility in detecting various physiological and pathological conditions.
Pineal germinomas with granulomatous inflammation Report of two cases and review of the literature
Authors: Murakami Masaji , Kuratsu Jun-ichi , Kochi Masato , Kunitoku Naoko , Hashiguchi Akihito , Ushio Yukitaka
Published: January 2008

The authors report on two cases of pineal germinomas with granulomatous inflammation (granulomatous germinomas). Macroscopically, both tumors were relatively hard and grayish in color. Histological examination revealed a germinoma with multinucleated giant cells and Schaumann bodies in one case, and a germinoma with the background of acellular fibrillated matrix in the other. On immunohistochemical analysis, the granulomatous germinomas were shown to contain many macrophages, T- and B-lymphocytes, and glial fibrillary acid protein-positive cells infiltrating the specimens, compared to nongranulomatous germinomas. Analysis of Masson's trichrome staining tests showed that large areas of the granulomatous germinomas were occupied by a collagenous component; this was not the case in cases of nongranulomatous germinomas. Analysis of monoclonal anti-human Ki-67 results showed that the granulomatous germinomas had a lower score than nongranulomatous germinomas (p < 0.05, unpaired t-test), indicating that germinomas with granulomatous inflammation may have a better prognosis.
Methylprednisolone or tirilazad mesylate administration after acute spinal cord injury: 1-year follow up
Authors: Bracken Michael B. , Shepard Mary Jo , Holford Theodore R. , Leo-Summers Linda , Aldrich E. Francois , Fazl Mahmood , Fehlings Michael G. , Herr Daniel L. , Hitchon Patrick W. , Marshall Lawrence F. , Nockels Russ P. , Pascale Valentine , Perot Phanor L. , Piepmeier Joseph , Sonntag Volker K. H. , Wagner Franklin , Wilberger Jack E. , Winn H. Richard , Young Wise
Published: January 2008

Object

A randomized double-blind clinical trial was conducted to compare neurological and functional recovery and morbidity and mortality rates 1 year after acute spinal cord injury in patients who had received a standard 24-hour methylprednisolone regimen (24MP) with those in whom an identical MP regimen had been delivered for 48 hours (48MP) or those who had received a 48-hour tirilazad mesylate (48TM) regimen.

Methods

Patients for whom treatment was initiated within 3 hours of injury showed equal neurological and functional recovery in all three treatment groups. Patients for whom treatment was delayed more than 3 hours experienced diminished motor function recovery in the 24MP group, but those in the 48MP group showed greater 1-year motor recovery (recovery scores of 13.7 and 19, respectively, p = 0.053).A greater percentage of patients improving three or more neurological grades was also observed in the 48MP group (p = 0.073). In general, patients treated with 48TM recovered equally when compared with those who received 24MP treatments. A corresponding recovery in self care and sphincter control was seen but was not statistically significant. Mortality and morbidity rates at 1 year were similar in all groups.

Conclusions

For patients in whom MP therapy is initiated within 3 hours of injury, 24-hour maintenance is appropriate. Patients starting therapy 3 to 8 hours after injury should be maintained on the regimen for 48 hours unless there are complicating medical factors.
Apoptosis after traumatic human spinal cord injury
Authors: Emery Evelyne , Aldana Philipp , Bunge Mary Bartlett , Puckett William , Srinivasan Anu , Keane Robert W. , Bethea John , Levi Allan D. O.
Published: January 2008

Object

Apoptosis is a form of programmed cell death seen in a variety of developmental and disease states, including traumatic injuries. The main objective of this study was to determine whether apoptosis is observed after human spinal cord injury (SCI). The spatial and temporal expression of apoptotic cells as well as the nature of the cells involved in programmed cell death were also investigated.

Methods

The authors examined the spinal cords of 15 patients who died between 3 hours and 2 months after a traumatic SCI. Apoptotic cells were found at the edges of the lesion epicenter and in the adjacent white matter, particularly in the ascending tracts, by using histological (cresyl violet, hematoxylin and eosin) and nuclear staining (Hoechst 33342). The suspected presence of apoptotic cells was supported by staining with the terminal deoxynucleotidyl transferase-mediated biotinylated-deoxyuridinetriphosphate nick-end labeling technique and confirmed by immunostaining for the processed form of caspase-3 (CPP-32), a member of the interleukin-1-beta-converting enzyme/Caenorhabditis elegans D 3 family of proteases that plays an essential role in programmed cell death. Apoptosis in this series of human SCIs was a prominent pathological finding in 14 of the 15 spinal cords examined when compared with five uninjured control spinal cords. To determine the type of cells undergoing apoptosis, the authors immunostained specimens with a variety of antibodies, including glial fibrillary acidic protein, 2,′3′-cyclic nucleotide 3′-phosphohydrolase (CNPase), and CD45/68. Oligodendrocytes stained with CNPase and a number of apoptotic nuclei colocalized with positive staining for this antibody.

Conclusions

These results support the hypothesis that apoptosis occurs in human SCIs and is accompanied by the activation of CPP-32 of the cysteine protease family. This mechanism of cell death contributes to the secondary injury processes seen after human SCI and may have important clinical implications for the further development of protease inhibitors to prevent programmed cell death.
Pterional craniotomy via a transcavernous approach for the treatment of low-lying distal basilar artery aneurysms
Authors: Nutik Stephen L.
Published: January 2008

Object

The author describes a surgical procedure in which pterional craniotomy is performed via a transcavernous approach to treat low-lying distal basilar artery (BA) aneurysms. This intradural procedure is compared with the extradural procedure described by Dolenc, et al.

Methods

The addition of a transcavernous exposure to the standard pterional intradural transsylvian approach allows a lower exposure of the distal BA behind the dorsum sellae. The technical steps involved in this procedure are as follows: 1) removal of the anterior clinoid process; 2) entry into the cavernous sinus medial to the third nerve; 3) packing of the venous channels of the cavernous sinus lying between the carotid artery and the pituitary gland to open this space; 4) removal of the posterior clinoid process and the portion of the dorsum sellae that is exposed from within the cavernous sinus; and 5) removal of the exposed dura mater to obtain additional exposure of the perimesencephalic cistern. Eight cases of aneurysms of the distal BA are presented to illustrate how this approach can help in their surgical treatment.

Conclusions

Using the standard pterional approach, these distal BA aneurysms were found to be either too low relative to the posterior clinoid process for adequate exposure or there was insufficient room for temporary clipping of the BA proximal to the lesion. The addition of a transcavernous exposure eliminated these technical problems and aneurysm clipping could be accomplished in each case.
Role of basic fibroblast growth factor in the pathogenesis of moyamoya disease
Authors: Houkin Kiyohiro , Yoshimoto Tetsuyuki , Abe Hiroshi , Nagashima Kazuo , Nagashima Masahumi , Takeda Makoto , Isu Toyohiko
Published: January 2008

The pathogenesis of moyamoya disease is still under investigation. In this study, the authors focus on the role of cytokines in the pathogenesis of moyamoya disease by using immunohistochemical analyses.

The authors examined two specimens in the circle of Willis obtained at autopsy from two patients with moyamoya disease and two additional specimens obtained from control cadavers with atherosclerotic stenosis of the intracranial carotid arteries. Immunohistochemical examinations of the sections of the major intracranial arteries were performed using antismooth muscle cells (SMCs), monocytes, growth factor, cell nuclear antigen, and fragmented DNA antibodies. Basic fibroblast growth factor (bFGF) staining was present only in the endothelial cells of the moyamoya disease specimens and was not seen in control samples. In addition, the endothelial cells and SMCs in the media were positive for terminal deoxynucleotidyl transferase-mediated biotinylated deoxyuridine triphosphate nick-end labeling of fragmented DNA method but not in the SMCs in the intima in moyamoya disease specimens, which indicates that an apoptotic process is active in only SMCs in the media but not in the intima. In conclusion, it is suggseted that the presence of bFGF in the media specifically seen in moyamoya disease suppresses the apoptotic process of SMCs in the intima.
Comparison of positron emission tomography study results of cerebral hemodynamics in patients with bleeding- and ischemic-type moyamoya disease
Authors: Iwama Toru , Akiyama Yoshinori , Morimoto Masafumi , Kojima Akio , Hayashida Kohei
Published: January 2008

The purpose of this study was to elucidate the difference in cerebral hemodynamics and metabolic status between patients with bleeding- and ischemic-type moyamoya disease. Regional cerebral blood flow (rCBF), regional cerebral metabolic rate of oxygen (rCMRO2), regional oxygen extraction fraction (rOEF), and regional cerebral blood volume (rCBV) in the cortex of the middle cerebral artery (MCA) territories and rCBV in the striatum were measured using positron emission tomography (PET) in 17 patients with moyamoya disease. Patients were divided into three subgroups according to type of disease manifestation and age: adult bleeding type (five cases), adult ischemic type (10 cases), and childhood ischemic type (two cases). When compared with adult controls, statistically significant reductions in rCBF and rCMRO2, elevation in rOEF in the MCA territories, and elevation of rCBV in the striatum were observed in PET studies for all three subgroups. Between the adult bleeding type and ischemic type, rCBF, rCMRO2, and rOEF in the MCA territories were not different, but rCBV in the striatum was higher in patients with ischemic-type moyamoya disease than in those with the bleeding type. In adult patients with bleeding and ischemic types, rOEF and rCBV in the MCA territories and rCBV in the striatum were significantly lower than in patients with childhood ischemic-type moyamoya disease. In adult patients with bleeding-type moyamoya disease, cerebral hemodynamics were impaired and similar to those in adult ischemic type.
Carotid endarterectomy: current indications for surgery
Authors: Brennan James J. , Loftus Christopher M.
Published: January 2008

The study of carotid artery occlusive disease interventions can be divided clinically into the treatment of asymptomatic and symptomatic diseases. Clinical trials that have studied or are currently studying asymptomatic disease include: the Carotid Artery Stenosis with Asymptomatic Narrowing Operation Versus Aspirin study; the Mayo Asymptomatic Carotid Endarterectomy trial; Veterans Administration Cooperative Trial on Asymptomatic Carotid Stenosis; and the Asymptomatic Carotid Atherosclerosis Study. Trials for the treatment of symptomatic disease include: the North American Symptomatic Carotid Endarterectomy Trial; the European Carotid Surgery Trial; and the Veterans Administration Cooperative Study.

In the earliest trials conducted to study asymptomatic disease medical therapy was slightly favored; on close scrutiny these studies were flawed and the findings appeared to be equivocal. The more scientific and appropriate trial, which was ended due to ethical concerns, revealed a clear advantage in patients who underwent surgery for greater than 60% stenosis and when the surgical center demonstrated less than 3% surgical risks.

All trials studying symptomatic disease found a significant decrease in subsequent stroke when surgical intervention was performed. It is now judged that patients with greater than 50% stenosis receive significant benefit.

In this paper the authors review the data from all of these studies. They also review data for special circumstances, such as critical stenosis and patients with symptomatic and asymptomatic Hollenhorst plaques. It is their opinion that these data have allowed surgeons to make much more educated decisions when considering the treatment of patients with carotid artery occlusive disease.
Percutaneous transluminal angioplasty and stenting for recurrent carotid artery stenosis
Authors: Lanzino Giuseppe , Mericle Robert A. , Lopes Demetrius K. , Wakhloo Ajay K. , Guterman Lee R. , Hopkins L. Nelson
Published: January 2008

Percutaneous transluminal angioplasty (PTA) and stenting has recently been proposed as an alternative to surgical reexploration in patients with recurrent carotid artery stenosis following endarterectomy. The authors retrospectively reviewed their experience after performing 25 procedures in 21 patients to assess the safety and efficacy of PTA with or without stenting for carotid artery restenosis.

The mean interval between endarterectomy and the endovascular procedure was 57 months (range 8-220 months). Seven arteries in five patients were treated by PTA alone (including bilateral procedures in one patient and repeated angioplasty in the same vessel in another). Early suboptimum results and recurrent stenosis in some of these initial cases prompted the authors to combine PTA with stenting in the treatment of 18 arteries over the past 3 years.

No major periprocedural deficits (neurological or cardiac complications) or death occurred. There was one periprocedural transient neurological event. A pseudoaneurysm of the femoral artery (at the access site) required surgical repair. In the 16 patients who each underwent at least 6 months of follow-up review, no neurological events ipsilateral to the treated artery had occurred after a mean follow-up period of 27 months (range 6-57 months). Three of five patients who underwent PTA alone developed significant (> 50%) asymptomatic restenoses that required repeated angioplasty in one and PTA with stenting in two patients. Significant restenosis (55%) was observed in only one of the vessels treated by combined angioplasty with stenting. Endovascular PTA and stenting of recurrent carotid artery stenosis is both technically feasible and safe and has a satisfactory midterm patency. This procedure can be considered a viable alternative to surgical reexploration in patients with recurrent carotid artery stenosis.
Computer-generated surgical simulation of morphological changes in microstructures: concepts of “virtual retractor”
Authors: Koyama Toru , Okudera Hiroshi , Kobayashi Shigeaki
Published: January 2008

The author's goal was to develop a computer graphics model to simulate the displacement and morphological changes that are caused by the retraction of fine intracranial structures.

The authors developed an application program to interpolate the contour of models of an artery and a retractor. The center of the displacement was determined by spatial coordinates, and the shape of the displacement of the arterial model was calculated by using a cosine-based formula with representation of a brain retractor. This computer graphics model was applied to the simulation of the displacement and morphological changes that occur when retraction is performed in the optic nerve. An illustrative case is presented, in which the optic nerve was displaced by a retractor to simulate the surgery performed in a carotid cave aneurysm of the internal carotid artery.

The authors have named this methodological tool “virtual retractor.” This new navigational system for open microneurosurgery would be useful in teaching surgical microanatomy and in presurgical operative planning.
Clinical variability in patients with Apert's syndrome
Authors: Lajeunie Elisabeth , Cameron Rhoda , Ghouzzi Vincent El , de Parseval Nathalie , Journeau Pierre , Gonzales Marie , Delezoide Anne-Lise , Bonaventure Jacky , Le Merrer Martine , Renier Dominique
Published: January 2008

Object

Apert's syndrome is characterized by faciocraniosynostosis and severe bony and cutaneous syndactyly of all four limbs. The molecular basis for this syndrome appears remarkably specific: two adjacent amino acid substitutions (either S252W or P253R) occurring in the linking region between the second and third immunoglobulin domains of the fibroblast growth factor receptor (FGFR)2 gene. The goal of this study was to examine the phenotype/genotype correlations in patients with Apert's syndrome.

Methods

In the present study, 36 patients with Apert's syndrome were screened for genetic mutations. Mutations were detected in all cases. In one of the patients there was a rare mutation consisting of a double-base pair substitution in the same codon (S252F). A phenotypical survey of our cases was performed and showed the clinical variability of this syndrome. The P253R mutation appears to be associated with the more severe forms of Apert's syndrome with regard to the forms of syndactyly and to mental outcome. In two patients there was no clinical or radiological evidence of craniosynostosis. In two other patients with atypical forms of syndactyly and cranial abnormalities, the detection of a specific mutation was helpful in making the diagnosis.

Conclusions

The fact that mutations found in patients with Apert's syndrome are usually confined to a specific region of the FGFR2 exon IIIa may be useful in making a diagnosis.
Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management
Authors: Vale Fernando L. , Burns Jennifer , Jackson Amie B. , Hadley Mark N.
Published: January 2008

The optimal management of acute spinal cord injuries remains to be defined. The authors prospectively applied resuscitation principles of volume expansion and blood pressure maintenance to 77 patients who presented with acute neurological deficits as a result of spinal cord injuries occurring from C-1 through T-12 in an effort to maintain spinal cord blood flow and prevent secondary injury. According to the Intensive Care Unit protocol, all patients were managed by Swan-Ganz and arterial blood pressure catheters and were treated with immobilization and fracture reduction as indicated. Intravenous fluids, colloid, and vasopressors were administered as necessary to maintain mean arterial blood pressure above 85 mm Hg. Surgery was performed for decompression and stabilization, and fusion in selected cases. Sixty-four patients have been followed at least 12 months postinjury by means of detailed neurological assessments and functional ability evaluations.

Sixty percent of patients with complete cervical spinal cord injuries improved at least one Frankel or American Spinal Injury Association (ASIA) grade at the last follow-up review. Thirty percent regained the ability to walk and 20% had return of bladder function 1 year postinjury.

Thirty-three percent of the patients with complete thoracic spinal cord injuries improved at least one Frankel or ASIA grade. Approximately 10% of the patients regained the ability to walk and had return of bladder function.

As of the 12-month follow-up review, 92% of patients demonstrated clinical improvement after sustaining incomplete cervical spinal cord injuries compared to their initial neurological status. Ninety-two percent regained the ability to walk and 88% regained bladder function.

Eighty-eight percent of patients with incomplete thoracic spinal cord injuries demonstrated significant improvements in neurological function 1 year postinjury. Eighty-eight percent were able to walk and 63% had return of bladder function.

The authors conclude that the enhanced neurological outcome that was observed in patients after spinal cord injury in this study was in addition to, and/or distinct from, any potential benefit provided by surgery. Early and aggressive medical management (volume resuscitation and blood pressure augmentation) of patients with acute spinal cord injuries optimizes the potential for neurological recovery after sustaining trauma.
Epilepsy in children with shunted hydrocephalus
Authors: Bourgeois Marie , Sainte-Rose Christian , Cinalli Giuseppe , Maixner Wirginia , Malucci Conor , Zerah Michel , Pierre-Kahn Alain , Renier Dominique , Hoppe-Hirsch Elisabeth , Aicardi Jean
Published: January 2008

The incidence of epilepsy among children with hydrocephalus and its relation to shunts and their complications, raised intracranial pressure (ICP), and developmental outcome are explored in a retrospective study.

The authors studied a series of 802 children with hydrocephalus due to varying causes, who were treated by ventriculoperitoneal shunt placement between 1980 and 1990, with a mean follow-up period of 8 years. Patients who had tumoral hydrocephalus and those whose files lacked significant data were excluded. Data extracted from medical records, including history of the hydrocephalus and history of seizures, if any, were analyzed.

Thirty-two percent of the children had epilepsy, the onset of which frequently occurred at approximately the same time that the diagnosis of hydrocephalus was made. The majority of the affected children had severe uncontrolled epilepsy. The incidence of epilepsy was significantly affected by the original cause of the hydrocephalus. The presence of radiological abnormalities was also found to be a significant predictor of epilepsy. Similarly, shunt complications predisposed to epilepsy. Episodes of raised ICP related to hydrocephalus or in association with shunt malfunction may also predispose to epileptic seizures. Furthermore, the presence of a shunt by itself seems able to promote an epileptogenic focus. Finally, epilepsy appears to be an important predictor of poor intellectual outcome in hydrocephalic children with shunts.

A prospective study is needed to identify clearly and confirm avoidable factors predisposing to seizures in these children so that we can strive to reduce the incidence of these seizures and, subsequently, improve quality of life.
Acute postoperative seizures following anterior temporal lobectomy for intractable partial epilepsy
Authors: Malla Bhaskara Rao , O'Brien Terence J. , Cascino Gregory D. , So Elson L. , Radhakrishnan Kurupath , Silbert Peter , Marsh W. Richard
Published: January 2008

Recurrence of seizures immediately following epilepsy surgery can be emotionally devastating, and raises concerns about the chances of successfully attaining long-term seizure control. The goals of this study were to investigate the frequency of acute postoperative seizure (APOS) occurring in the 1st postoperative week following anterior temporal lobectomy (ATL) to identify potential risk factors and to determine their prognostic significance.

One hundred sixty consecutive patients who underwent an ATL for intractable nonlesional temporal lobe epilepsy were retrospectively studied. Acute postoperative seizures occurred in 32 patients (20%). None of the following factors were shown to be significantly associated with the occurrence of APOS: age at surgery, duration of epilepsy, side of surgery, extent of neocortical resection, electrocorticography findings, presence of mesial temporal sclerosis, and hippocampal volume measurements (p > 0.05). Patients who suffered from APOS overall had a lower rate of favorable outcome with respect to seizure control at the last follow-up examination than patients without APOS (62.5% compared with 83.6%, p < 0.05). The type of APOS was of prognostic importance, with patients whose APOS were similar to their preoperative habitual seizures having a significantly worse outcome than those whose APOS were auras or were focal motor and/or generalized tonic-clonic seizures (excellent outcome: 14.3%, 77.8%, and 75%, respectively, p < 0.05). Only patients who had APOS similar to preoperative habitual seizures were less likely to have an excellent outcome than patients without APOS (14.3% compared with 75%, p < 0.05). Timing of the APOS and identification of a precipitating factor were of no prognostic importance.

The findings of this study may be useful in counseling patients who suffer from APOS following ATL for temporal lobe epilepsy.
Postimaging brain distortion: magnitude, correlates, and impact on neuronavigation
Authors: Dorward Neil L. , Alberti Olaf , Velani Binti , Gerritsen Frans A. , Harkness William F. J. , Kitchen Neil D. , Thomas David G. T.
Published: January 2008

This prospective study was conducted to quantify brain shifts during open cranial surgery, to determine correlations between these shifts and image characteristics, and to assess the impact of postimaging brain distortion on neuronavigation.

During 48 operations, movements of the cortex on opening, the deep tumor margin, and the cortex at completion were measured relative to the preoperative image position with the aid of an image-guidance system. Bone surface offset was used to assess system accuracy and correct for registration errors. Preoperative images were examined for the presence of edema and to determine tumor volume, midline shift, and depth of the lesion below the skin surface. Results were analyzed for all cases together and separately for four tumor groups: 13 meningiomas, 18 gliomas, 11 nonglial intraaxial lesions, and six skull base lesions.

For all 48 cases the mean shift of the cortex after dural opening was 4.6 mm, shift of the deep tumor margin was 5.1 mm, and shift of the cortex at completion was 6.7 mm. Each tumor group displayed unique patterns of shift, with significantly greater shift at depth in meningiomas than gliomas (p = 0.007) and significantly less shift in skull base cases than other groups (p < 0.003). Whereas the preoperative image characteristics correlating with shift of the cortex on opening were the presence of edema and depth of the tumor below skin surface, predictors of shift at depth were the presence of edema, the lesion volume, midline shift, and magnitude of shift of the cortex on opening.

This study quantified intraoperative brain distortion, determined the different behavior of tumors in four pathological groups, and identified preoperative predictors of shift with which the reliability of neuronavigation may be estimated.
Complete endoscopic removal of colloid cysts: issues of safety and efficacy
Authors: Teo Charles
Published: January 2008

The ideal management of colloid cysts is controversial. Treatment options include shunting procedures, stereotactic cyst aspiration, open craniotomy for microsurgical removal, and endoscopic removal. Although recent literature would suggest endoscopic removal is a reasonable approach, issues of safety and efficacy have dampened the universal acceptance of this surgical modality. The author performed a retrospective anaylsis to address these controversial issues.

The charts of all patients in whom endoscopic removal of colloid cysts was performed by the primary author at the University of Arkansas for Medical Sciences were reviewed. Eighteen patients underwent this procedure over the last 5 years. The mean patient age was 32 years, and the mean follow-up period was 32 months. In all patients complete tumor removal was macroscopically and radiologically confirmed, and there were no permanent deficits. Two patients suffered aseptic meningitis without long-term sequelae. There were no deaths and no incidence of tumor recurrence.

The results of this series support those previously published that underscore the advantages of endoscopic removal of colloid cysts. The procedure is safe and effective. Longer follow-up review is required to address the issue of duration of tumor-free survival.