bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stroke-free Survival and Its Determinants in Patients with Symptomatic Vertebrobasilar Stenosis: A Multicenter Study
Authors: Qureshi Adnan I. , Suri M. Fareed K. , Ziai Wendy C. , Yahia Abutaher M. , Mohammad Yousef , Sen Souvik , Agarwal Pinky , Zaidat Osama O. , Suarez Jose I. , Wityk Robert J. 
Published: February 2017

Abstract

OBJECTIVE
We sought to determine the long-term stroke-free survival of patients who present with ischemic events related to intracranial vertebrobasilar stenosis.

METHODS
A retrospective cohort of patients diagnosed with symptomatic vertebrobasilar stenosis on the basis of magnetic resonance angiography and/or conventional angiography was identified at four academic medical centers. Patients' clinical and follow-up information was obtained through hospitalization records, clinic visits, and telephone interviews. Kaplan-Meier analysis was performed to determine the rate of stroke-free survival for a 5-year period. Cox proportional hazards analysis was performed to determine the effect of demographic and clinical factors on stroke-free survival.

RESULTS
A total of 102 patients were included, whose mean age was 64 ± 12 years. Fifty-five (54%) of the patients were men. The mean follow-up period was 15 ± 15.9 months (range, 1–60 mo). During the follow-up period, 14 (14%) of the patients experienced recurrent stroke. The overall mortality rate was 21% (n = 21). Stroke-free survival, calculated by using the Kaplan-Meier curve, was 76% at 12 months (95% confidence interval [CI], 66–83%) and 48% at 5 years (95% CI, 27–65%). The risk of recurrent stroke was 10.9 per 100 patient-years, and the rate of recurrent stroke and/or death was 24.2 per 100 patient-years. Cox proportional hazards analysis revealed that increasing age (hazards ratio, 1.05; 95% CI, 1.00–1.09) decreased stroke-free survival. Treatment with either antiplatelet agents or warfarin (hazards ratio, 0.018; 95% CI, 0.003–0.11) had a protective effect on stroke-free survival after adjusting for age, sex, race, hypertension, diabetes mellitus, smoking, hyperlipidemia, and lesion location.

CONCLUSION
A low rate of stroke-free survival is observed in patients with symptomatic vertebrobasilar stenosis. Further studies are required to evaluate new medical and endovascular treatment options for this group of patients to improve long-term stroke-free survival.
Outcome and Cost of Craniotomy Performed to Treat Tumors in Regional Academic Referral Centers
Authors: Long Donlin M. , Gordon Toby , Bowman Helen , Etzel Anthony , Burleyson Gregg , Betchen Simone , Garonzik Ira M. , Brem Henry 
Published: February 2017

Abstract

OBJECTIVE
Improved clinical and economic outcomes for high-risk surgical procedures have been previously cited in support of regionalization. The goal of this study was to examine the effects of regionalization by analyzing the cost and outcome of craniotomy for tumors and to compare the findings in academic medical centers versus community-based hospitals.

METHODS
Outcomes and charges were analyzed for all adult patients undergoing craniotomy for tumor in 33 nonfederal acute care hospitals in Maryland using the Maryland Health Service Cost Review Commission database for the years 1990 to 1996. A total of 4723 patients who underwent craniotomy for tumor were selected on the basis of Diagnostic Related Group 1 (craniotomy except for trauma, age 18 or older) and International Classification of Diseases–9th Revision diagnosis code for benign tumor, primary malignant neoplasm, or secondary malignant neoplasm (codes 191, 192, 194, 200, 225, 227, 228, 237, and 239). Hospitals were categorized as high-volume hospitals (&gt;50 craniotomies/yr) or low-volume hospitals (≤50 craniotomies/yr). In-hospital mortality, length of stay, and charges were evaluated.

RESULTS
The mortality rate was 2.5% at high-volume centers and 4.9% at low-volume hospitals with an adjusted relative risk of 1.4 (P &lt; 0.05), assuming equivalence of disease severity. Adjusted average length of stay in high-volume centers was 6.8, as compared with 8.8 days in low-volume hospitals (P &lt; 0.001). Adjusted average total charges were $15,867 at high-volume centers and $14,045 at low-volume centers (P &lt; 0.001). If all patients in the state had been treated at centers with survival rates equal to those achieved by the high-volume centers, then 46 patients would not have died of operation; that is, 48.6% fewer patients would have died, at an additional adjusted cost of $76,395 dollars per patient saved.

CONCLUSION
High-volume regional medical centers are capable of providing services with improved mortality rates and fewer hospital days, although with adjusted costs slightly higher than those at low-volume hospitals.
Alcohol Embolization of Carotid-Cavernous Indirect Fistulae
Authors: Koebbe Christopher J. , Horowitz Michael , Jungreis Charles , Levy Elad , Pless Misha 
Published: February 2017

Abstract

OBJECTIVE
Carotid-cavernous fistulae (CCFs) are abnormal communications between the carotid artery and cavernous sinus that may present with rapid visual deterioration and extraocular paresis as a result of increasing intraocular pressure requiring emergent treatment to preserve vision. We present a technique of balloon-assisted ethanol embolization of the cavernous carotid artery supply to indirect CCFs providing immediate reduction in intraocular pressure with symptomatic improvement.

METHODS
We reviewed clinical and angiographic data and present a retrospective case series illustrating six patients who underwent endovascular embolization because of worsening visual acuity and extraocular motility disorder caused by CCFs. Cerebral angiography revealed significant blood supply from the cavernous carotid artery to these CCFs. We performed ethanol embolization of these branches with distal balloon protection.

RESULTS
Five of the six patients experienced immediate and sustained (mean follow-up, 21 mo) decreases in intraocular pressure, with significant symptom improvement. One patient experienced cavernous sinus thrombosis after conclusion of embolization, which caused a temporary worsening of symptoms that improved gradually over time.

CONCLUSION
Many surgical and endovascular options are available to treat indirect CCFs. Absolute ethanol is a liquid agent that causes immediate vessel sclerosis and occlusion, which makes it a dangerous but potent liquid embolic agent. With distal temporary balloon protection to prevent migration of ethanol, we achieved excellent clinical and angiographic results using absolute ethanol to embolize the cavernous carotid supply to indirect CCFs. This represents a safe and effective method of endovascular management of this complex vascular anomaly.
Inferior Temporal Sulcus Approach for Amygdalohippocampectomy Guided by a Laser Beam of Stereotactic Navigator
Authors: Miyagi Yasushi , Shima Fumio , Ishido Katsuya , Araki Takehisa , Taniwaki Yoshihide , Okamoto Iku , Kamikaseda Kazufumi 
Published: February 2017

Abstract

OBJECTIVE
To describe a surgical technique for a minimally invasive transcortical transventricular amygdalohippocampectomy via the inferior temporal sulcus (ITS) using a stereotactic navigator.

METHODS
Seven patients with medically intractable mesial temporal lobe epilepsy underwent an amygdalohippocampectomy via the ITS. By use of a laser-guided navigation system, the epileptogenic foci of the mesial temporal lobe were resected through a small linear operative route that was made by a brain speculum inserted from the ITS to the anterolateral floor of the temporal horn in the lateral ventricle.

RESULTS
All patients completed at least a 1-year follow-up (range, 14–45 mo) after surgery and had improved neuropsychological parameters as a result of the operation. All patients became seizure-free after surgery. A Humphrey visual field perimeter detected no hemianopsia.

CONCLUSION
Combined with the stereotactic navigation system, the ITS approach provides the least invasive amygdalohippocampectomy that preserves optic radiation. This approach seems beneficial especially in patients in whom the epileptic lesions are limited to the anterior mesial temporal lobe.
A Surgical Technique for Safely Placing a Drug Delivery Catheter into the Pons of Primates: Preliminary Results of Carboplatin Infusion
Authors: Storm Phillip B. , Clatterbuck Richard E. , Liu Ya J. , Johnson Randolph M. , Gillis Edward M. , Guarnieri Michael , Carson Benjamin S. 
Published: February 2017

Abstract

OBJECTIVE
We sought to develop a neurosurgical procedure to access the pons with a drug delivery device for chronic therapy and collect preliminary data on the toxicity of direct infusions of carboplatin in primates.

METHODS
We made midline incisions on five cynomolgus monkeys, identified the inion, made a burr hole 2.5 cm below the inion, and inserted a catheter through the cerebellum into the roof of the pons. Pumps that infused saline for 90 days or carboplatin solutions for 30 to 35 days at 10 μl/d were placed subcutaneously in the low cervical/high thoracic region. Monkeys were assessed by computed tomography and magnetic resonance imaging, laboratory studies, daily neurological observation, postmortem examinations, and histopathology.

RESULTS
Monkeys infused with saline and 82 μg of carboplatin remained neurologically intact throughout the infusion periods. Serial imaging showed that the catheter tip was in the pons and revealed no evidence of hemorrhage, edema, or migration. Two monkeys infused with up to 850 μg of carboplatin showed hyperintense magnetic resonance imaging signals at Days 15 and 18 and neurological deficits at approximately Week 3. Platinum levels greater than 10 ng/mg tissue were detected over a distance of 1 cm in tissue slices. Histopathology demonstrated significant tissue necrosis around the tip of the catheter.

CONCLUSION
The pons of monkeys is safely accessed with a catheter for drug delivery by using a posterior midline approach. Clinical observations, radiographic imaging, and laboratory tests of animals infused with saline for 3 months or 0.26 mg/ml of carboplatin for 1 month were unremarkable. Neurotoxicity was seen with dose levels of 2.6 mg/ml of drug for 1 month. This procedure offers opportunities for examining the toxicity of brainstem antitumor therapy in primates.
Resection Followed by Radiosurgery for Advanced Juvenile Nasopharyngeal Angiofibroma: Report of Two Cases
Authors: Dare Amos O. , Gibbons Kevin J. , Proulx Gary M. , Fenstermaker Robert A. 
Published: February 2017

Abstract

OBJECTIVE AND IMPORTANCE
Experience with the management of juvenile nasopharyngeal angiofibroma (JNA) by gamma knife radiosurgery is limited. We report control of the disease in two patients with advanced-stage JNA treated with primary resection followed by gamma knife stereotactic radiosurgery of residual disease.

CLINICAL PRESENTATION
An 18-year-old man presented with chronic sinusitis, worsening headaches, diplopia, and left-sided facial numbness. A second patient, a 19-year-old man, presented with recurrent epistaxis and nasal congestion. Magnetic resonance imaging findings and endoscopic evaluation in each patient were consistent with advanced-stage JNA.

INTERVENTION
One patient underwent craniofacial resection with approximately 3.0 cm3of residual tumor in the region of the cavernous sinus. The other patient underwent preoperative embolization followed by a lateral rhinotomy for tumor resection with approximately 4.7 cm3of residual tumor in the right infratemporal fossa. In an attempt to limit radiation to surrounding normal brain, residual tumor in both patients was treated with gamma knife stereotactic radiosurgery. Control of disease was documented by magnetic resonance imaging more than 24 months after treatment.

CONCLUSION
Short-term control of late-stage JNA was achieved by use of a strategy of primary surgical resection followed by gamma knife radiosurgery of residual tumor in two patients. Establishing the effectiveness and safety of this strategy over conventional methods of managing advanced JNA will require future prospective studies.
Aneurysms at a Temporopolar Artery Origin from the Internal Carotid Artery: Report of Two Cases
Authors: Alkadhi Hatem , Schuknecht Bernhard , Imhof Hans-Georg , Yonekawa Yasuhiro 
Published: February 2017

Abstract

OBJECTIVE AND IMPORTANCE
Origination of the temporopolar artery (TPA) from the supraclinoid internal carotid artery (ICA) represents a rare anatomic variation, and the presence of aneurysms at this uncommon site has never before been reported.

CLINICAL PRESENTATION
Two patients presented with a sudden onset of headaches and meningism. Computed tomography demonstrated diffuse subarachnoid hemorrhage in both cases. Cerebral angiography revealed ruptured aneurysms originating at a TPA origin from the ICA.

INTERVENTION
The patients were surgically treated, and the aneurysms were successfully clipped. For technical reasons, the TPA was sacrificed in both cases.

CONCLUSION
These are the first reported cases of aneurysms originating at the TPA origin from the ICA. Awareness of the existence of this variation is necessary, particularly for the management of superior wall aneurysms of the ICA.
Preoperative Evaluation of Neural Tracts by Use of Three-dimensional Anisotropy Contrast Imaging in a Patient with Brainstem Cavernous Angioma: Technical Case Report
Authors: Kashimura Hiroshi , Inoue Takashi , Ogasawara Kuniaki , Ogawa Akira 
Published: February 2017

Abstract

OBJECTIVE AND IMPORTANCE
We describe a case of brainstem cavernous angioma in which the neural tracts were evaluated before surgery by three-dimensional anisotropy contrast (3-DAC) magnetic resonance imaging.

CLINICAL PRESENTATION
A 64-year-old man presented with a cavernous angioma located intrinsically in the brainstem and manifesting as gait ataxia. 3-DAC imaging demonstrated that the lesion was located outside the left inferior cerebellar peduncle and inside the middle cerebellar peduncle.

INTERVENTION
The intact brain surface was incised, and the lesion was removed successfully on the basis of the preoperative 3-DAC images. The patient exhibited temporary exacerbation of his gait ataxia, but the symptom improved 3 months after surgery. Postoperative 3-DAC imaging demonstrated resection of the lesion and preservation of the left inferior and middle cerebellar peduncles.

CONCLUSION
3-DAC imaging may provide essential information about the neural tracts for the planning of brainstem surgery.
Anterior Endoscopic Treatment of a Huge Anterior Sacral Meningocele: Technical Case Report
Authors: Jeon Byung-Chan , Kim Do-Heon , Kwon Ki-Young 
Published: February 2017

Abstract

OBJECTIVE AND IMPORTANCE
Anterior endoscopic treatment of a huge anterior sacral meningocele, a rare example of spinal dysraphism, is described.

CLINICAL PRESENTATION
A 43-year-old woman presented with severe headache and fever, increasing abdominal pain, and a several-year history of right lower-extremity radicular pain. She exhibited meningeal irritation signs and Currarino's triad. Lumbosacral myelograms and magnetic resonance imaging scans revealed a huge anterior sacral cyst connected with the spinal subarachnoid space.

INTERVENTION
A straight rigid endoscope was introduced into the meningocele through a small abdominal incision. The fistula between the meningocele and the spinal subarachnoid space was obliterated with multiple fat grafts harvested from the abdomen.

CONCLUSION
An anterior endoscopic procedure is an alternative for the treatment of a huge anterior sacral meningocele.
Simulated Lumbar Minimally Invasive Surgery Educational Model With Didactic and Technical Components
Authors: Chitale Rohan , Ghobrial George M. , Lobel Darlene , Harrop James 
Published: February 2017

Abstract

BACKGROUND:
The learning and development of technical skills are paramount for neurosurgical trainees. External influences and a need for maximizing efficiency and proficiency have encouraged advancements in simulator-based learning models.

OBJECTIVE:
To confirm the importance of establishing an educational curriculum for teaching minimally invasive techniques of pedicle screw placement using a computer-enhanced physical model of percutaneous pedicle screw placement with simultaneous didactic and technical components.

METHODS:
A 2-hour educational curriculum was created to educate neurosurgical residents on anatomy, pathophysiology, and technical aspects associated with image-guided pedicle screw placement. Predidactic and postdidactic practical and written scores were analyzed and compared. Scores were calculated for each participant on the basis of the optimal pedicle screw starting point and trajectory for both fluoroscopy and computed tomographic navigation.

RESULTS:
Eight trainees participated in this module. Average mean scores on the written didactic test improved from 78% to 100%. The technical component scores for fluoroscopic guidance improved from 58.8 to 52.9. Technical score for computed tomography—navigated guidance also improved from 28.3 to 26.6.

CONCLUSION:
Didactic and technical quantitative scores with a simulator-based educational curriculum improved objectively measured resident performance. A minimally invasive spine simulation model and curriculum may serve a valuable function in the education of neurosurgical residents and outcomes for patients.
Translating the Simulation of Procedural Drilling Techniques for Interactive Neurosurgical Training
Authors: Stredney Don , Rezai Ali R. , Prevedello Daniel M. , Elder J. Bradley , Kerwin Thomas , Hittle Bradley , Wiet Gregory J. 
Published: February 2017

AbstractBACKGROUND:Through previous efforts we have developed a fully virtual environment to provide procedural training of otologic surgical technique. The virtual environment is based on high-resolution volumetric data of the regional anatomy. These volumetric data help drive an interactive multisensory, ie, visual (stereo), aural (stereo), and tactile, simulation environment. Subsequently, we have extended our efforts to support the training of neurosurgical procedural technique as part of the Congress of Neurological Surgeons simulation initiative.OBJECTIVE:To deliberately study the integration of simulation technologies into the neurosurgical curriculum and to determine their efficacy in teaching minimally invasive cranial and skull base approaches.METHODS:We discuss issues of biofidelity and our methods to provide objective, quantitative and automated assessment for the residents.RESULTS:We conclude with a discussion of our experiences by reporting preliminary formative pilot studies and proposed approaches to take the simulation to the next level through additional validation studies.CONCLUSION:We have presented our efforts to translate an otologic simulation environment for use in the neurosurgical curriculum. We have demonstrated the initial proof of principles and define the steps to integrate and validate the system as an adjuvant to the neurosurgical curriculum.
The Development of a Virtual Simulator for Training Neurosurgeons to Perform and Perfect Endoscopic Endonasal Transsphenoidal Surgery
Authors: Rosseau Gail , Bailes Julian , del Maestro Rolando , Cabral Anne , Choudhury Nusrat , Comas Olivier , Debergue Patricia , De Luca Gino , Hovdebo Jordan , Jiang Di , Laroche Denis , Neubauer Andre , Pazos Valerie , Thibault Francis , DiRaddo Robert 
Published: February 2017

AbstractBACKGROUND:A virtual reality (VR) neurosurgical simulator with haptic feedback may provide the best model for training and perfecting surgical techniques for transsphenoidal approaches to the sella turcica and cranial base. Currently there are 2 commercially available simulators: NeuroTouch (Cranio and Endo) developed by the National Research Council of Canada in collaboration with surgeons at teaching hospitals in Canada, and the Immersive Touch. Work in progress on other simulators at additional institutions is currently unpublished.OBJECTIVE:This article describes a newly developed application of the NeuroTouch simulator that facilitates the performance and assessment of technical skills for endoscopic endonasal transsphenoidal surgical procedures as well as plans for collecting metrics during its early use.METHODS:The main components of the NeuroTouch-Endo VR neurosurgical simulator are a stereovision system, bimanual haptic tool manipulators, and high-end computers. The software engine continues to evolve, allowing additional surgical tasks to be performed in the VR environment. Device utility for efficient practice and performance metrics continue to be developed by its originators in collaboration with neurosurgeons at several teaching hospitals in the United States. Training tasks are being developed for teaching 1- and 2-nostril endonasal transsphenoidal approaches. Practice sessions benefit from anatomic labeling of normal structures along the surgical approach and inclusion (for avoidance) of critical structures, such as the internal carotid arteries and optic nerves.CONCLUSION:The simulation software for NeuroTouch-Endo VR simulation of transsphenoidal surgery provides an opportunity for beta testing, validation, and evaluation of performance metrics for use in neurosurgical residency training.
Visual-Vestibular Habituation and Balance Training for Motion Sickness
Authors: Rine Rose Marie , Schubert Michael C , Balkany Thomas J 
Published: February 2017

Abstract
Background and Purpose. This case report describes physical therapy for motion sickness in a 34-year-old woman. The purpose of the report is twofold: (1) to provide an overview of the literature regarding motion sickness syndrome, causal factors, and rationale for treatment and (2) to describe the evaluation and treatment of a patient with motion sickness. Case Description and Outcomes. The patient initially had moderate to severe visually induced motion sickness, which affected her functional abilities and prevented her from working. Following 10 weeks of a primarily home-based program of visual-vestibular habituation and balance training, her symptoms were alleviated and she could resume all work-related activities. Discussion. Although motion sickness affects nearly one third of all people who travel by land, sea, or air, little documentation exists regarding prevention or management.
Cough Threshold in People With Spinal Cord Injuries
Authors: Lin Kwan-Hwa , Lai Yih-Loong , Wu Huey-Dong , Wang Tyng-Quey , Wang Yen-Ho 
Published: February 2017

Abstract
Background and Purpose. The purpose of this study was to compare the cough threshold between people with and without spinal cord injury (SCI). The effect of smoking on cough threshold was also investigated. Subjects. The participants were 26 people with SCI (15 smokers, 11 nonsmokers) and 18 people without SCI (9 smokers, 9 nonsmokers). Methods. Aerosols of citric acid were delivered with incremental doubling concentration from 62.5 mmol to 2 mol. Cough threshold was defined as the first concentration of citric acid that induced at least 2 coughs, which is associated with large chest excursion and concurrently acoustic response. Results. The mean cough thresholds of smokers and nonsmokers with SCI (209 and 417 mmol, respectively) were lower than those of smokers and nonsmokers without SCI (467 and 1,072 mmol, respectively). The mean citric acid cough thresholds decreased in smokers with and without SCI when compared with nonsmokers with and without SCI. Conclusion and Discussion. The cough sensitivity increased in subjects with SCI, and smoking could also increase the cough sensitivity. Training about the frequency and technique of cough in patients with SCI should be carefully monitored.