bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contemporary analysis of the intraoperative and perioperative complications of neurosurgical procedures performed in the sitting position
Authors: Himes Benjamin T. , Mallory Grant W. , Abcejo Arnoley S. , Pasternak Jeffrey , Atkinson John L. D. , Meyer Fredric B. , Marsh W. Richard , Link Michael J. , Clarke Michelle J. , Perkins William , Van Gompel Jamie J. 
Published: August 2016

OBJECTIVEHistorically, performing neurosurgery with the patient in the sitting position offered advantages such as improved visualization and gravity-assisted retraction. However, this position fell out of favor at many centers due to the perceived risk of venous air embolism (VAE) and other position-related complications. Some neurosurgical centers continue to perform sitting-position cases in select patients, often using modern monitoring techniques that may improve procedural safety. Therefore, this paper reports the risks associated with neurosurgical procedures performed in the sitting position in a modern series.METHODSThe authors reviewed the anesthesia records for instances of clinically significant VAE and other complications for all neurosurgical procedures performed in the sitting position between January 1, 2000, and October 8, 2013. In addition, a prospectively maintained morbidity and mortality log of these procedures was reviewed for instances of subdural or intracerebral hemorrhage, tension pneumocephalus, and quadriplegia. Both overall and specific complication rates were calculated in relation to the specific type of procedure.RESULTSIn a series of 1792 procedures, the overall complication rate related to the sitting position was 1.45%, which included clinically significant VAE, tension pneumocephalus, and subdural hemorrhage. The rate of any detected VAE was 4.7%, but the rate of VAE requiring clinical intervention was 1.06%. The risk of clinically significant VAE was highest in patients undergoing suboccipital craniotomy/craniectomy with a rate of 2.7% and an odds ratio (OR) of 2.8 relative to deep brain stimulator cases (95% confidence interval [CI] 1.2–70, p = 0.04). Sitting cervical spine cases had a comparatively lower complication rate of 0.7% and an OR of 0.28 as compared with all cranial procedures (95% CI 0.12–0.67, p < 0.01). Sitting cervical cases were further subdivided into extradural and intradural procedures. The rate of complications in intradural cases was significantly higher (OR 7.3, 95% CI 1.4–39, p = 0.02) than for extradural cases. The risk of VAE in intradural spine procedures did not differ significantly from sitting suboccipital craniotomy/craniectomy cases (OR 0.69, 95% CI 0.09–5.4, p = 0.7). Two cases (0.1%) had to be aborted intraoperatively due to complications. There were no instances of intraoperative deaths, although there was a single death within 30 days of surgery.CONCLUSIONSIn this large, modern series of cases performed in the sitting position, the complication rate was low. Suboccipital craniotomy/craniectomy was associated with the highest risk of complications. When appropriately used with modern anesthesia techniques, the sitting position provides a safe means of surgical access.
Repeat stereotactic radiosurgery as salvage therapy for locally recurrent brain metastases previously treated with radiosurgery
Authors: McKay Will H. , McTyre Emory R. , Okoukoni Catherine , Alphonse-Sullivan Natalie K. , Ruiz Jimmy , Munley Michael T. , Qasem Shadi , Lo Hui-Wen , Xing Fei , Laxton Adrian W. , Tatter Stephen B. , Watabe Kounosuke , Chan Michael D. 
Published: August 2016

OBJECTIVEThere are a variety of salvage options available for patients with brain metastases who experience local failure after stereotactic radiosurgery (SRS). These options include resection, whole-brain radiation therapy, laser thermoablation, and repeat SRS. There is little data on the safety and efficacy of repeat SRS following local failure of a prior radiosurgical procedure. This study evaluates the clinical outcomes and dosimetric characteristics of patients who experienced tumor recurrence and were subsequently treated with repeat SRS.METHODSBetween 2002 and 2015, 32 patients were treated with repeat SRS for local recurrence of ≥ 1 brain metastasis following initial SRS treatment. The Kaplan-Meier method was used to estimate time-to-event outcomes including overall survival (OS), local failure, and radiation necrosis. Cox proportional hazards analysis was performed for predictor variables of interest for each outcome. Composite dose-volume histograms were constructed for each reirradiated lesion, and these were then used to develop a predictive dosimetric model for radiation necrosis.RESULTSForty-six lesions in 32 patients were re-treated with a second course of SRS after local failure. A median dose of 20 Gy (range 14–22 Gy) was delivered to the tumor margin at the time of repeat SRS. Local control at 1 year was 79% (95% CI 67%–94%). Estimated 1-year OS was 70% (95% CI 55%–88%). Twelve patients had died at the most recent follow-up, with 8/12 patients experiencing neurological death (as described in Patchell et al.). Eleven of 46 (24%) lesions in 11 separate patients treated with repeat SRS were associated with symptomatic radiation necrosis. Freedom from radiation necrosis at 1 year was 71% (95% CI 57%–88%). Analysis of dosimetric data revealed that the volume of a lesion receiving 40 Gy (V40Gy) was the most predictive factor for the development of radiation necrosis (p = 0.003). The following V40Gy thresholds were associated with 10%, 20%, and 50% probabilities of radiation necrosis, respectively: 0.28 cm3 (95% CI 3%–28%), 0.76 cm3 (95% CI 9%–39%), 1.60 cm3 (95% CI 26%–74%).CONCLUSIONSRepeat SRS appears to be an effective salvage option for patients with brain metastases experiencing local failure following initial SRS treatment. This series demonstrates durable local control and, although rates of radiation necrosis are significant, repeat SRS may be indicated for select cases of local disease recurrence. Because the V40Gy is predictive of radiation necrosis, limiting this value during treatment planning may allow for a reduction in radiation necrosis rates.
Endoscope-assisted transsphenoidal puncture of the cavernous sinus for embolization of carotid-cavernous fistula in a neurosurgical hybrid operating suite
Authors: Tang Chien-Lun , Liao Chih-Hsiang , Chen Wen-Hsien , Shen Shih-Chieh , Lee Chung-Hsin , Lee Hsu-Tung , Tsuei Yuang-Seng 
Published: August 2016

Endovascular embolization is the treatment of choice for carotid-cavernous fistulas (CCFs), but failure to catheterize the cavernous sinus may occur as a result of vessel tortuosity, hypoplasia, or stenosis. In addition to conventional transvenous or transarterial routes, alternative approaches should be considered. The authors present a case in which a straightforward route to the CCF was accessed via transsphenoidal puncture of the cavernous sinus in a neurosurgical hybrid operating suite.This 82-year-old man presented with severe chemosis and proptosis of the right eye. Digital subtraction angiography revealed a Type B CCF with a feeding artery arising from the meningohypophyseal trunk of the right cavernous segment of the internal carotid artery. The CCF drained through a thrombosed right superior ophthalmic vein that ended deep in the orbit; there were no patent sinuses or venous plexuses connecting to the CCF. An endoscope-assisted transsphenoidal puncture created direct access to the nidus for embolization. Embolic agents were deployed through the puncture needle to achieve complete obliteration. Endoscope-assisted transsphenoidal puncture of the cavernous sinus is a feasible alternative to treat difficult-to-access CCFs in a neurosurgical hybrid operating suite.
Vascular permeability and iron deposition biomarkers in longitudinal follow-up of cerebral cavernous malformations
Authors: Girard Romuald , Fam Maged D. , Zeineddine Hussein A. , Tan Huan , Mikati Abdul Ghani , Shi Changbin , Jesselson Michael , Shenkar Robert , Wu Meijing , Cao Ying , Hobson Nicholas , Larsson Henrik B. W. , Christoforidis Gregory A. , Awad Issam A. 
Published: August 2016

OBJECTIVEVascular permeability and iron leakage are central features of cerebral cavernous malformation (CCM) pathogenesis. The authors aimed to correlate prospective clinical behavior of CCM lesions with longitudinal changes in biomarkers of dynamic contrast-enhanced quantitative permeability (DCEQP) and quantitative susceptibility mapping (QSM) assessed by MRI.METHODSForty-six patients with CCMs underwent 2 or more permeability and/or susceptibility studies in conjunction with baseline and follow-up imaging and clinical surveillance during a mean 12.05 months of follow-up (range 2.4–31.27 months). Based on clinical and imaging features, cases/lesions were classified as stable, unstable, or recovering. Associated and predictive changes in quantitative permeability and susceptibility were investigated.RESULTSLesional mean permeability and QSM values were not significantly different in stable versus unstable lesions at baseline. Mean lesional permeability in unstable CCMs with lesional bleeding or growth increased significantly (+85.9% change; p = 0.005), while mean permeability in stable and recovering lesions did not significantly change. Mean lesional QSM values significantly increased in unstable lesions (+44.1% change; p = 0.01), decreased slightly with statistical significance in stable lesions (−3.2% change; p = 0.003), and did not significantly change in recovering lesions. Familial cases developing new lesions during the follow-up period showed a higher background brain permeability at baseline (p = 0.001), as well as higher regional permeability (p = 0.003) in the area that would later develop a new lesion as compared with the homologous contralateral brain region.CONCLUSIONSIn vivo assessment of vascular permeability and iron deposition on MRI can serve as objective and quantifiable biomarkers of disease activity in CCMs. This may be applied in natural history studies and may help calibrate clinical trials. The 2 techniques are likely applicable in other disorders of vascular integrity and iron leakage such as aging, hemorrhagic microangiopathy, and traumatic brain injury.
Effect of supporting 3D-garment on gait postural stability in children with bilateral spastic cerebral palsy
Authors: Degelaen Marc , De Borre Ludo , Buyl Ronald , Kerckhofs Eric , De Meirleir Linda , Dan Bernard 
Published: August 2016

BACKGROUND: Children with cerebral palsy show dysfunctional postural control which interferes with their functional performance and daily-life activities. OBJECTIVE: The aim of the study was to identify the effect of a 3D supporting garment on trunk postural control and interjoint coordination during gait in children with bilateral cerebral palsy. METHODS: We analyzed tridimensional trunk motion, trunk-thigh and interjoint coordination in 15 4–10 year-old children with bilateral spastic cerebral palsy (GMFCS I or II) and 16 4–10 year-old typically developing children while walking with or without a supporting garment. RESULTS: We found significantly changes in the coordination between trunk and lower limbs in children with cerebral palsy. Step velocity and cadence both increased significantly in children with cerebral palsy but in controls, the cadence remained unaltered. Interjoint coordination between hip-knee and knee-ankle was altered during the stance phase only in the subgroup of children with cerebral palsy without any limitations in ankle joint passive range of motion. CONCLUSION: 3D supporting garments improve trunk-thigh and lower limb interjoint coordination in walking in children with bilateral cerebral palsy.
Functional assessment of immediate task planning and execution by adults with acquired brain injury
Authors: Brown Jessica A. , Hux Karen 
Published: August 2016

BACKGROUND: Individuals with acquired brain injury (ABI) often struggle planning and executing tasks outside daily routines. Given the pervasive effects executive functioning challenges have on independent living, professionals need methods of assessing these skills. OBJECTIVE: This study’s purpose was to evaluate an ecologically-valid procedure to assess novel task planning and execution by adults with ABI. METHODS: The researchers implemented a single group design across two phases. Participants included nine adults with severe ABI. In the first experimental phase, participants created a plan for executing tasks that required adherence to pre-determined rules; in the second phase, participants executed the tasks. The researchers tallied information units recorded during the planning phase, performed momentary time-sampling to document observations about participant behaviors, and collected speed, accuracy, and rule violation data about task completion. RESULTS: Planning strategies implemented by most participants were limited to word-for-word copying of some or all of the specified tasks. On average, participants attempted and accurately performed less than half the required tasks and exhibited high rule violation rates. CONCLUSIONS: Given further development and refinement, the implemented procedures may serve as a basis for developing an ecologically-valid tool for evaluating executive functioning in adults with ABI.
Coping and adaptive strategies of traumatic brain injury survivors and primary caregivers
Authors: Adams Deana , Dahdah Marie 
Published: August 2016

BACKGROUND: Qualitative research methods allowed the investigator to contribute to the development of new theories and to examine change in processes over time, which added rich detail to existing knowledge of the use of coping and adaptive strategies by traumatic brain injury survivors and their primary caregivers ( Ponsford, Sloan, & Snow, 2013 ). The advantages of phenomenological study were that it allows flexibility to explore and understand meanings attached by people to well-studied concepts such as coping, resiliency, and adaptation or compensation. Phenomenological study was sensitive to contextual factors. It also permitted the study of in-depth dynamics of coping and adaptive strategies of TBI survivors and primary caregivers, while understanding the social and psychological implications of the phenomenon. OBJECTIVE: To explore the needs and deficits of adult traumatic brain injury (TBI) survivors and primary caregivers; and to identify their self-initiated coping and adaptive strategies. Significant to this study was the development of coping and adaptive strategies by the participants after their discharge from inpatient and rehabilitation treatment. The compensatory skills taught in treatment settings did not transfer to the home environment. Therefore, these strategies developed independently from previous treatment recommendations contributed to the development of theory related to rehabilitation and counseling. Distinctive to this study was the similarity of coping and adaptive strategies developed from both mild and severe traumatic brain injury survivors. METHODS: This study consisted of eleven with TBI and six primary caregivers (N = 17), who participated in a series of semi-structured interviews aimed at discovering the coping and adaptive strategies utilized in dealing with the effects of brain injury. A Qualitative Phenomenological design was employed. RESULTS: Patience and understanding, support, and professional help were identified by TBI survivors and caregivers as being their most relevant needs. Self-reported deficits included short-term memory loss (STM), fatigue, anger, and personality changes, and the strategies that TBI survivors and caregivers identified tended to address their problems with these specific day-to-day deficits. Problem focused, emotion focused, and avoidant coping were utilized to some degree in their adjustment to home life and activities of daily living. Participants offered suggestions for mental health professionals addressing how to more effectively work with brain injury survivors and their primary caregivers. CONCLUSION: TBI survivors and caregivers had multiple self-reported unaddressed needs following their discharge from facility-based treatment. They reported spontaneously engaging in various coping and adaptive strategies to address their needs and deficits. However, further education regarding potential post-TBI challenges and strategies for addressing them are needed, including a need for community and mental health resources.
Driving assessment and rehabilitation using a driving simulator in individuals with traumatic brain injury: A scoping review
Authors: Imhoff Sarah , Lavallière Martin , Teasdale Normand , Fait Philippe 
Published: August 2016

BACKGROUND: Due to the heterogeneity of the lesion following a traumatic brain injury (TBI) and the complexity of the driving task, driving assessment and rehabilitation in TBI individuals is challenging. Conventional driving assessment (on-road and in-clinic evaluations) has failed demonstrating effectiveness to assess fitness to drive in TBI individuals. OBJECTIVE: We aimed to determine if driving simulators represent an interesting opportunity in assessing and rehabilitating driving skills in TBI individuals. METHODS: We searched PubMed, CINAHL and Cochrane library databases between 27-02-2014 and 08-04-2014 for articles published since 2000 with the contents of simulator driving assessment and rehabilitation. RESULTS: Out of 488, eight articles with the subject of simulator driving assessment and two with the subject of simulator driving rehabilitation in individuals with TBI were reviewed. CONCLUSIONS: Driving simulators represent a promising avenue for the assessment and rehabilitation of driving skills in TBI individuals as it allows control of stimuli in a safe, challenging and ecologically valid environment and offer the opportunity to measure and record driving performance. Additional studies, however, are needed to document strengths and limitations of this method.
Impact of central facial palsy and dysarthria on quality of life in patients with stroke: The KOSCO study
Authors: Chang Won Hyuk , Sohn Min Kyun , Lee Jongmin , Kim Deog Young , Lee Sam-Gyu , Shin Yong-Il , Oh Gyung-Jae , Lee Yang-Soo , Joo Min Cheol , Han Eun Young , Kim Yun-Hee 
Published: August 2016

BACKGROUND: There are a few reports on the impact of central facial palsy and dysarthria on quality of life (QOL) in stroke patients. OBJECTIVE: To investigate the impact of central facial palsy on QOL compared with dysarthria during the chronic phase in patients with first-ever strokes. METHODS: This study represents an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation study. We selected data from patients with functional independence of 0 or 1 by the modified Rankin Scale at 6 months after stroke onset, who showed an impairment only in National Institute of Health Stroke Scale items 4 (facial palsy) or 10 (dysarthria). Assessments included the European Quality of Life-5 Dimensions (EQ-5D) and the Geriatric depression scale-short form (GDS-SF). RESULTS: Data from 149 patients were selected for this analysis from 3,929 patients who were followed up at 6 months. Thirty-nine and 110 patients were classified into the facial palsy and dysarthria groups, respectively. The groups did not differ significantly in baseline characteristics or functional assessments. EQ-5D was significantly lower in the facial palsy group than in the dysarthria group at 6 months after stroke ( p = 0.036). GDS-SF was significantly higher in the facial palsy group than in the dysarthria group ( p = 0.005). CONCLUSIONS: The results of this study revealed that central facial palsy clearly has a more negative impact on QOL than dysarthria in chronic stroke patients with functional independence.
Action research in rehabilitation with chronic stroke recovery: A case report with a focus on neural plasticity
Authors: Pedersen Malene , Bundgaard Tina H. , Zeeman Peter , Jørgensen Jørgen R. , Sørensen Peter M.B. , Berro Hamza M. , Larsson Bodil W. 
Published: August 2016

BACKGROUND: Chronic stroke patients are primarily referred to general rehabilitation, rather than to specific neurorehabilitation. Currently, there are no Danish clinical guidelines for chronic stroke, but recent research in neuroplasticity has contributed to possible rehabilitation interventions for these patients. OBJECTIVE: The purpose of this project is to describe the use of a specialized neuroplastic approach in combination with an already existing training program. METHODS: The project is designed as an action research project concerning four participants with chronic stroke. Through ten intervention, a neuroplastic focus has been added to their group training program including daily home training. Participants were tested before and after the intervention with MAS, DGI, 6MWT, SSQLS. RESULTS: All four participants improved their functional levels and their quality of life following the intervention. CONCLUSIONS: This report indicates that a specific neuroplastic focus in combination with action research has an impact on the participants with chronic stroke. However, there is still no clarity regarding what type of rehabilitation methods can be considered the most efficacious in promoting neuroplasticity. This case report serves as a pilot project for further studies of how to implement neuroplasticity in physical therapy.
Swallowing characteristics in Amyotrophic Lateral Sclerosis
Authors: Jani Mansi Pankaj , Gore Geeta Bharat 
Published: August 2016

BACKGROUND: Motor neurone disease also commonly known as Amyotrophic Lateral Sclerosis (ALS) is a neurological condition which affects various motor functions of the body. Dysphagia (disordered swallowing) is commonly seen in patients with ALS having bulbar symptoms. OBJECTIVES: Research reveals presence of dysphagia in patients with ALS at various stages of swallowing using instrumental assessment. However, very few studies have been done focussing on clinical profiling of swallowing in these patients. Hence, a need was felt to profile the specific characteristics. METHODOLOGY: Five patients diagnosed with ALS were assessed for presence of swallowing disorder using a swallowing checklist which focussed on assessing each stage of swallowing. RESULTS: Results revealed that patients with ALS exhibit difficulties in oral preparatory, oral and pharyngeal stages of swallowing. Inability to hold bolus, reduced mastication, residue in the oral cavity and nasal regurgitation while swallow were observed due to the affected oromotor functions. Swallow reflex was delayed in all the patients. Cough before and during swallow was also observed. CONCLUSION: Dysphagia is a common symptom in patients with ALS and occurs due to the affected oromotor functions. Specific information of the stages of swallowing helps in planning treatment in clinical practice.