bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Indications to Maintain Quality of Life in Elderly Patients with Ruptured Intracranial Aneurysms
Authors: Yano Shigetoshi , Hamada Jun-ichiro , Kai Yutaka , Todaka Tatemi , Hara Tsuyoshi , Mizuno Takamasa , Morioka Motohiro , Ushio Yukitaka 
Published: February 2017

Abstract

OBJECTIVE
We performed a retrospective study to assess long-term outcomes in very old patients with ruptured intracranial aneurysms. The aim of the study was to develop guidelines for choosing surgical or conservative treatment with the goal of maintaining patients' quality of life.

METHODS
Between 1996 and 1999, 76 consecutive patients, aged 80 to 89 years, with ruptured intracranial aneurysms were treated at 18 participating centers. They were divided retrospectively into operated and nonoperated groups, and their preoperative characteristics and treatment outcomes were analyzed. Their Glasgow Outcome Scale and Barthel Index scores at least 2 years after the insult were recorded and analyzed from the perspective of their admission Hunt and Hess grade.

RESULTS
Our retrospective review encompassed 5.9 years. Of the original 76 patients, 54 (71.1%) died, 13 (17.1%) had a good outcome (Barthel Index ≥60), and 9 (11.8%) had a poor outcome (Barthel Index &lt;60). All patients with Hunt and Hess grades of III or higher at admission had poor outcomes irrespective of treatment. Of 32 patients with an initial Hunt and Hess grade of I or II, 19 (59.4%) underwent surgery; 9 of these patients (47.4%) had good outcomes. Conversely, of 13 nonoperated patients (40.6%), only 2 (15.4%) experienced good outcomes. In seven of the nine operated patients with good outcomes, the aneurysm was small (&lt;12 mm) and located at the internal carotid artery-posterior communicating artery junction.

CONCLUSION
Our results suggest that patients in the 9th decade of life with ruptured intracranial aneurysms can be considered for surgical treatment if they have a Hunt and Hess grade of I or II. The highest rate of favorable results was achieved in patients with small internal carotid artery-posterior communicating artery aneurysms.
Pulmonary Complications of Aneurysmal Subarachnoid Hemorrhage
Authors: Friedman Jonathan A. , Pichelmann Mark A. , Piepgras David G. , McIver Jon I. , Toussaint L. Gerard , McClelland Robyn L. , Nichols Douglas A. , Meyer Fredric B. , Atkinson John L.D. , Wijdicks Eelco F.M. 
Published: February 2017

Abstract

OBJECTIVE
Pulmonary complications challenge the medical management of patients who have sustained aneurysmal subarachnoid hemorrhage (SAH). We assessed the frequency and types of pulmonary complications after aneurysmal SAH and analyzed the impact of pulmonary complications on patient outcome.

METHODS
We reviewed the records of all patients with acute SAH treated at our institution between 1990 and 1997. Three hundred five consecutive patients with an aneurysmal hemorrhage source documented by angiography and treated within 7 days of ictus were analyzed. Outcomes at longest follow-up (mean, 16 mo) were measured by use of the Glasgow Outcome Scale.

RESULTS
Pulmonary complications were documented in 66 patients (22%). The pulmonary complications were nosocomial pneumonia in 26 patients (9%), congestive heart failure in 23 (8%), aspiration pneumonia in 17 (6%), neurogenic pulmonary edema in 5 (2%), pulmonary embolus in 2 (&lt;1%), and other pulmonary disorders in 4 (1%); 11 patients had two pulmonary complications. The incidence of symptomatic vasospasm was greater in patients with pulmonary complications (63%) than in patients without pulmonary complications (31%) (P= 0.001), and this association was independent of age and clinical grade at admission (odds ratio, 3.68; P&lt; 0.001). Overall clinical outcomes were worse in patients with pulmonary complications (mean Glasgow Outcome Scale score, 3.3) than in patients without pulmonary complications (mean Glasgow Outcome Scale score, 4.0; P= 0.0001), but pulmonary complications were not an independent predictor of worse outcome when adjusted for age and clinical grade at admission (odds ratio, 1.38; P= 0.315).

CONCLUSION
Patients who experience pulmonary complications after aneurysmal SAH have a higher incidence of symptomatic vasospasm than do patients without pulmonary complications. This most likely reflects both the failure to maintain aggressive hypervolemic and hyperdynamic therapy in patients with pulmonary compromise and the possible precipitation of congestive heart failure by hypervolemic therapy in patients with preexisting delayed ischemic neurological deficit. Although patients with pulmonary complications have worse overall clinical outcomes than do patients without pulmonary complications, this is attributable to older age and worse clinical grades at admission.
Radiosurgery Followed by Planned Observation in Patients with One to Three Brain Metastases
Authors: Lutterbach Johannes , Cyron Donatus , Henne Karl , Ostertag Christoph B. 
Published: February 2017

Abstract

OBJECTIVE
To analyze the role of radiosurgery alone in patients with brain metastases. There were three specific study goals: 1) to determine whether survival of patients selected for this treatment approach can be predicted successfully by use of the recursive partitioning analysis classification defined by the Radiation Therapy Oncology Group; 2) to evaluate local control; and 3) to identify risk factors of cerebral failure.

METHODS
A total of 101 patients with Karnofsky Performance Scale scores of at least 50 and up to three brain metastases, each 3 cm or less in maximum diameter, were treated with radiosurgery alone. Survival, local control, distant brain freedom from progression (FFP), and overall brain FFP were evaluated according the method of Kaplan and Meier. Risk factors for survival and overall brain FFP were analyzed using the Cox model.

RESULTS
Median survival was 13.4 months, 9.3 months, and 1.5 months for patients in recursive partitioning analysis Classes 1, 2, and 3, respectively (P&lt; 0.0001). At 1 year, local control, distant brain FFP, and overall brain FFP were 91, 53, and 51%, respectively. An interval greater than 2 years between diagnosis of the primary tumor and diagnosis of brain metastases and the presence of a single brain metastasis were associated with significantly higher overall brain FFP.

CONCLUSION
Recursive partitioning analysis classification successfully predicted survival. Radiosurgery alone yielded high local control. Overall brain FFP was highest in patients with an interval greater than 2 years between primary diagnosis and diagnosis of a single brain metastasis.
Anterior Screw Fixation in Type II Odontoid Fractures: Is There a Difference in Outcome between Age Groups?
Authors: Börm Wolfgang , Kast Erich , Richter Hans-Peter , Mohr Klaus 
Published: February 2017

AbstractOBJECTIVEOptimal treatment of elderly patients with Type II odontoid fractures is controversial. Suggestions vary between conservative management and different types of early surgery. Recent data confirm that early surgery may be warranted because conservative treatment has a high rate of failure in the elderly.METHODSWe performed a case-control study of 27 patients with Type II odontoid fracture who were treated with anterior odontoid double-screw fixation at our institution. The aim of the study was to determine whether patients aged 70 years or older have a less favorable outcome than younger patients with this operative technique. Cases were defined as patients with Type II odontoid fracture aged 70 years or older. All patients younger than 70 years served as controls.RESULTSThere were 15 patients aged 70 years or older (Group 1) and 12 patients younger than 70 years of age (Group 2). Mean follow-up was 16.6 months. Mean interval between fracture and surgery was 10 days. All patients were treated with anterior odontoid screw fixation by use of two compression screws. Fusion rates were 73% in Group 1 and 75% in Group 2. Additional dorsal stabilization was performed in 13% of cases in Group 1 and 17% of cases in Group 2. Complications occurred in 20% of cases in Group 1 and 8% of cases in Group 2. The only death occurred in Group 1, leading to 7% mortality in this group. Neurological status at admission and after treatment was similar in both groups. Statistical analysis did not reveal significant differences between groups for the factors studied.CONCLUSIONOutcome after anterior odontoid screw fixation is not affected by patient age. Slightly higher rates of medical complications did not reach statistical significance. Because conservative management of odontoid fractures in the elderly has a high rate of failure, anterior stabilization for Type II odontoid fractures can be recommended.
Use of Tisseel Fibrin Sealant in Neurosurgical Procedures: Incidence of Cerebrospinal Fluid Leaks and Cost-Benefit Analysis in a Retrospective Study
Authors: Kassam Amin , Horowitz Michael , Carrau Ricardo , Snyderman Carl , Welch William , Hirsch Barry , Chang Yue Fang 
Published: February 2017

AbstractOBJECTIVETo determine the clinical efficacy and cost effectiveness of using the fibrin sealant (FS) Tisseel (Baxter Healthcare Corp., Deerfield, IL) for patients undergoing anterior cranial base, infratemporal, and retromastoid surgical procedures.METHODSA retrospective review was performed, comparing two matched populations of patients who underwent surgical procedures using anterior cranial, infratemporal, or retromastoid approaches to intracranial pathological lesions. The incidences of cerebrospinal fluid (CSF) leaks in matched groups treated with the FS Tisseel or treated without FS were compared. The costs of Tisseel use were examined in comparison with the costs of postoperative management of CSF leaks and/or tension pneumocranium with spinal drainage and occasionally surgical reexploration, when lumbar drainage failed.RESULTSPatients who received the FS Tisseel exhibited no detectable postoperative CSF leaks or tension pneumocranium. Patients who did not receive Tisseel demonstrated 4 to 16% incidences of postoperative leaks, depending on the surgical approach used. The costs of treating those leaks far exceeded the costs of using Tisseel, even if it were used indiscriminately for all patients.CONCLUSIONThis retrospective review indicates that the FS Tisseel reduces the incidence of postoperative CSF leaks and tension pneumocranium while reducing overall management costs. Further prospective study is needed to determine which patients can benefit most from FS use.
Intrasellar Schwannomas: Report of Two Cases
Authors: Maartens Nicholas F. , Ellegala Dilantha B. , Vance Mary Lee , Lopes M. Beatriz S. , Laws Edward R. 
Published: February 2017

Abstract

OBJECTIVE AND IMPORTANCE
The complex regional anatomic features surrounding the sella turcica make the differential diagnosis of intrasellar and parasellar lesions complicated. Sellar and parasellar schwannomas are rare. With the exclusion of parasellar schwannomas arising from cranial nerves within the cavernous sinus and extending into the sella, there have been only two reported cases of true intrasellar schwannomas.

CLINICAL PRESENTATION
We describe the clinical, radiological, and pathological features of two cases in which the histopathological diagnosis of schwannoma was confirmed with immunohistochemical analyses and/or electron microscopy.

INTERVENTION
The two cases were grossly resected via a transsphenoidal approach. Follow-up monitoring revealed no evidence of recurrence.

CONCLUSION
Schwannomas may atypically occur in the sellar region, in which they demonstrate the typical light microscopic, immunohistochemical, and ultrastructural features observed in the peripheral nervous system. New and existing hypotheses regarding the histopathogenesis of intrasellar and parasellar schwannomas are presented.
Leptomeningeal Hemangioblastomatosis in a Case of von Hippel-Lindau Disease: Case Report
Authors: Reyns Nicolas , Assaker Richard , Louis Etienne , Lejeune Jean-Paul 
Published: February 2017

Abstract

OBJECTIVE AND IMPORTANCE
We report a unique case of extended leptomeningeal hemangioblastomatosis in a patient presenting with clinical von Hippel-Lindau disease.

CLINICAL PRESENTATION
A 50-year-old male patient had a history of three surgical procedures for the removal of a cerebellar hemangioblastoma, initially considered to be a recurrence of a sporadic form at the same location. Seven years after the last operation, he developed chronic hydrocephalus. Despite a ventriculoperitoneal shunt procedure, he experienced progressive worsening of gait disturbances, associated with touch numbness of the lower limbs and Parinaud's syndrome. Magnetic resonance imaging of the brain and spine showed evidence of leptomeningeal contrast enhancement around the brainstem, spinal cord, and cauda equina and enlarged tortuous vessels around the mesencephalon.

INTERVENTION
A lumbar laminectomy allowed a leptomeningeal biopsy. Pathological examination revealed leptomeningeal spread of the hemangioblastoma. It is assumed that the tumor arose in the pia mater and that its direction of growth was purely extramedullary, invading all subarachnoid spaces. The patient had a poor outcome as a result of progressive tetraplegia and died 6 months after diagnosis as a result of respiratory failure.

CONCLUSION
To the best of our knowledge, the clinical course of our patient, consistent with a thick leptomeningeal spread of hemangioblastoma from the posterior fossa to the sacrum, is unique. Nevertheless, the short life expectancy of our patient is usual in von Hippel-Lindau disease. This case report illustrates the crucial challenge to develop a specific drug therapy related to angiogenesis in von Hippel-Lindau disease.
In-hospital Mortality and Morbidity after Surgical Treatment of Unruptured Intracranial Aneurysms in the United States, 1996–2000: The Effect of Hospital and Surgeon Volume
Authors: Barker Fred G. , Amin-Hanjani Sepideh , Butler William E. , Ogilvy Christopher S. , Carter Bob S. 
Published: February 2017

Abstract

OBJECTIVE
We sought to determine the risk of adverse outcome after contemporary surgical treatment of patients with unruptured intracranial aneurysms in the United States. Patient, surgeon, and hospital characteristics were tested as potential outcome predictors, with particular attention to the surgeon's and hospital's volume of care.

METHODS
We performed a retrospective cohort study with the Nationwide Inpatient Sample, 1996 to 2000. Multivariate logistic and ordinal regression analyses were performed with endpoints of mortality, discharge other than to home, length of stay, and total hospital charges.

RESULTS
We identified 3498 patients who were treated at 463 hospitals, and we identified 585 surgeons in the database. Of all patients, 2.1% died, 3.3% were discharged to skilled-nursing facilities, and 12.8% were discharged to other facilities. The analysis adjusted for age, sex, race, primary payer, four variables measuring acuity of treatment and medical comorbidity, and five variables indicating symptoms and signs. The statistics for median annual number of unruptured aneurysms treated were eight per hospital and three per surgeon. High-volume hospitals had fewer adverse outcomes than hospitals that handled comparatively fewer unruptured aneurysms: discharge other than to home occurred after 15.6% of operations at high-volume hospitals (20 or more cases/yr) compared with 23.8% at low-volume hospitals (fewer than 4 cases/yr) (P = 0.002). High surgeon volume had a similar effect (15.3 versus 20.6%, P = 0.004). Mortality was lower at high-volume hospitals (1.6 versus 2.2%) than at hospitals that handled comparatively fewer unruptured aneurysms, but not significantly so. Patients treated by high-volume surgeons had fewer postoperative neurological complications (P = 0.04). Length of stay was not related to hospital volume. Charges were slightly higher at high-volume hospitals, partly because arteriography was performed more frequently than at hospitals that handled comparatively fewer unruptured aneurysms.

CONCLUSION
For patients with unruptured aneurysms who were treated in the United States between 1996 and 2000, surgery performed at high-volume institutions or by high-volume surgeons was associated with significantly lower morbidity and modestly lower mortality.
Developing an Anterior Cervical Diskectomy and Fusion Simulator for Neurosurgical Resident Training
Authors: Ray Wilson Z. , Ganju Aruna , Harrop James S. , Hoh Daniel J. 
Published: February 2017

AbstractBACKGROUND:Surgical simulators are useful in many surgical disciplines to augment residency training. Duty hour restrictions and increasing emphasis on patient safety and attending oversight have changed neurosurgical education from the traditional apprenticeship model. The Congress of Neurological Surgeons Simulation Committee has been developing neurosurgical simulators for the purpose of enhancing resident education and assessing proficiency.OBJECTIVE:To review the initial experience with an anterior cervical diskectomy and fusion (ACDF) simulator.METHODS:The first ACDF training module was implemented at the 2012 Congress of Neurological Surgeons Annual Meeting. The 90-minute curriculum included a written pretest, didactics, a practical pretest on the simulator, hands-on training, a written posttest, a practical posttest, and postcourse feedback. Didactic material covered clinical indications for ACDF, comparison with other cervical procedures, surgical anatomy and approach, principles of arthrodesis and spinal fixation, and complication management. Written pretests and posttests were administered to assess baseline knowledge and evidence of improvement after the module. Qualitative evaluation of individual performance on the practical (simulator) portion was included.RESULTS:Three neurosurgery residents, 2 senior medical students, and 1 attending neurosurgeon participated in the course. The pretest scores were an average 9.2 (range, 6-13). Posttest scores improved to 11.0 (range, 9-13; P = .03).CONCLUSION:Initial experience with the ACDF simulator suggests that it may represent a meaningful training module for residents. Simulation will be an important training modality for residents to practice surgical technique and for teachers to assess competency. Further development of an ACDF simulator and didactic curriculum will require additional verification of simulator validity and reliability.
Ketoprofen Tissue Permeation in Swine Following Cathodic Iontophoresis
Authors: Panus Peter C , Ferslew Kenneth E , Tober-Meyer Brunhilde , Kao Race L 
Published: February 2017

AbstractBackground and Purpose. Pharmacokinetic assessment of drug tissue permeation following iontophoresis is limited. The depth of ketoprofen tissue permeation following cathodic iontophoresis (4 mA, 40 minutes) and the stereoselectivity of drug delivery were examined in this study.Subjects. Ketoprofen (750 mg) was iontophoresed onto one porcine medial thigh, with passive drug permeation conducted on the other thigh.Methods. Skin, subcutaneous fascia, and muscle biopsies from the drug delivery sites were harvested and stored separately, and the “R” and “S” ketoprofen enantiomers were determined.Results. Iontophoretic and passive applications yielded equivalent total ketoprofen concentrations in the skin and fascia. In contrast, multivariate analysis demonstrated that the ketoprofen concentration in the first centimeter of muscle following iontophoresis was greater than the drug concentration in the deeper underlying muscle layers and greater than that delivered to any muscle layer following passive delivery. No transcutaneous stereoselective delivery of ketoprofen was detected.Conclusion and Discussion. Compared with passive delivery, iontophoresis enhances nonstereoselective ketoprofen permeation into the fascia-muscle interface. With delivery to deeper tissue sites, however, there is no apparent enhancement over passive application.
Quadriceps Femoris and Hamstring Muscle Function in a Person With an Unstable Knee
Authors: Maitland Murray E , Ajemian Stanley V , Suter Esther 
Published: February 2017

Abstract
Background and Purpose. The purpose of this case report is to describe the evaluation, treatment, and short-term outcome for an individual with chronic, progressively worsening instability of the knee during gait associated with anterior cruciate ligament (ACL) insufficiency.Case Description. The patient was a 34-year-old man who sustained bilateral ACL injuries. Subsequently, an autograft reconstruction of the left knee ACL was performed. Eight months post-reconstruction, the left knee was unstable despite bracing. Gait analysis and tests to determine the presence of muscle inhibition were performed prior to and after 12 weeks of training. Isometric torque of the knee extensors and flexors was measured with the knee in 90 degrees of flexion. A training program primarily consisted of electromyographic biofeedback during thigh muscle exercises, balance exercises, and gait.Outcomes. Muscle inhibition decreased and maximal isometric knee flexion and extension torques increased during the 12-week training period. Gait analysis demonstrated a 50% decrease in the maximum knee extensor moment and an increase in walking speed.Discussion. Selected gait variables, torque production, and muscle inhibition may change in a person with an unstable knee. The measurement of variables that have previously been documented as mechanisms of knee instability during walking allows for the selection of a specific treatment approach.
Speed-Dependent Reductions of Force Output in People With Poststroke Hemiparesis
Authors: Brown David A , Kautz Steven A 
Published: February 2017

AbstractBackground and Purpose. Movement is slow in people with poststroke hemiparesis. Moving at faster speeds is thought by some researchers to exacerbate of abnormal or unwanted muscle activity. The purpose of this study was to quantify the effects of increased speed on motor performance during pedaling exercise in people with poststroke hemiparesis. Subjects. Twelve elderly subjects with no known neurological impairment and 15 subjects with poststroke hemiparesis of greater than 6 months' duration were tested. Methods. Subjects pedaled at 12 randomly ordered workload and cadence combinations (45-, 90-, 135-, and 180-J workloads at 25, 40, and 55 rpm). Pedal reaction forces were used to calculate work done by each lower extremity. Electromyographic activity was recorded from 7 lower-extremity muscles. Results. The main finding was that net mechanical work done by the paretic lower extremity decreased as speed increased in all subjects. The occurrence of inappropriate muscle activity on the paretic side, however, was not exacerbated in that the vastus medialis muscle on the paretic side did not show a consistent further increase in its prolonged activity at higher speeds. The mechanics of faster pedaling resulted in greater net negative mechanical work because, at higher pedaling rates, the prolonged vastus medialis muscle activity is present during a greater portion of the cycle. Conclusion and Discussion. The lessened force output by the paretic limb is mainly the result of the inherent mechanical demands of higher-speed pedaling and not due to exacerbation of impaired neural control.