bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neurosurgical implications of allergic fungal sinusitis
Authors: Liu James K. , Schaefer Steven D. , Moscatello Augustine L. , Couldwell William T. 
Published: May 2009

Object. Allergic fungal sinusitis (AFS) is a form of paranasal mycosis that often involves bone destruction and extension into the orbit and anterior skull base. Treatment consists of surgical extirpation and a course of corticosteroids. Despite frequent intracranial involvement, AFS is rarely reported in the neurosurgical literature.
Methods. The records of 21 patients with the histological diagnosis of AFS were reviewed. The histological diagnosis was based on findings of branching septated fungi interspersed with eosinophilic mucin and Charcot—Leyden crystals without fungal invasion of soft tissue.
The average age of the 21 patients in this study was 25 years (range 9–46) and the male/female ratio was 3.75:1. All patients were immunocompetent. All had a history of chronic sinusitis and imaging findings of expansile disease involving multiple sinuses. Fifteen patients had nasal polyposis, eight had erosion of bone, which was observed on computerized tomography (CT) scans, eight had disease extending intracranially, and six had disease that involved the lamina papyracea. All patients underwent transnasal and/or transmaxillary endoscopic approaches for debridement and irrigation, six underwent orbital decompression, and three underwent a bifrontal craniotomy for removal of intracranial extradural disease. No patient had a cerebrospinal fluid leak. Postoperatively, one patient was treated with amphotericin B and the other 20 were treated with a short course of corticosteroids. The follow-up period ranged from 2 to 19 years.
Conclusions. Allergic fungal sinusitis is a unique form of fungal disease that may mimic anterior skull base and paranasal sinus tumors. A cranial base team approach of neurosurgeons and otolaryngologists is recommended. Most cases can be successfully managed with transnasal and/or transmaxillary endoscopic techniques. A craniotomy is rarely indicated unless there is the suspicion of dural invasion or extensive intracranial and/or intraorbital involvement that is inaccessible from below.
Microsurgical anatomy of the insula and the sylvian fissure
Authors: Tanriover Necmettin , Rhoton Albert L. , Kawashima Masatou , Ulm Arthur J. , Yasuda Alexandre 
Published: May 2009

Object. The purpose of this study was to define the topographic anatomy, arterial supply, and venous drainage of the insula and sylvian fissure.
Methods. The neural, arterial, and venous anatomy of the insula and sylvian fissure were examined in 43 cerebral hemispheres.
Conclusions. The majority of gyri and sulci of the frontoparietal and temporal opercula had a constant relationship to the insular gyri and sulci and provided landmarks for approaching different parts of the insula. The most lateral lenticulostriate artery, an important landmark in insular surgery, arose 14.6 mm from the apex of the insula and penetrated the anterior perforated substance 15.3 mm medial to the limen insulae. The superior trunk of the middle cerebral artery (MCA) and its branches supplied the anterior, middle, and posterior short gyri; the anterior limiting sulcus; the short sulci; and the insular apex. The inferior trunk supplied the posterior long gyrus, inferior limiting sulcus, and limen area in most hemispheres. Both of these trunks frequently contributed to the supply of the central insular sulcus and the anterior long gyrus. The areas of insular supply of the superior and inferior trunks did not overlap. The most constant insular area of supply by the cortical MCA branches was from the prefrontal and precentral arteries that supplied the anterior and middle short gyri, respectively. The largest insular perforating arteries usually arose from the central and angular arteries and most commonly entered the posterior half of the central insular sulcus and posterior long gyrus. Insular veins drained predominantly to the deep middle cerebral vein, although frequent connections to the superficial venous system were found. Of all the insular veins, the precentral insular vein was the one that most commonly connected to the superficial sylvian vein.
Association between an aplastic basilar artery, unaccompanied by a primitive carotid—vertebrobasilar anastomosis, and multiple aneurysms on the dominant posterior communicating artery
Authors: Behari Sanjay , Krishna Himanshu , Kiran Kumar Marakani V. , Sawlani Vijay , Phadke Rajendra V. , Jain Vijendra K. 
Published: May 2009

✓ Basilar artery (BA) aplasia when unaccompanied by a primitive carotid—vertebrobasilar anastomosis is exceedingly rare. The association of BA aplasia with two aneurysms on the dominant posterior communicating artery (PCoA) has not been previously reported.
This 40-year-old man presented in a state of drowsiness and responded to simple commands only after being coaxed. He had complete left cranial third nerve palsy, right hemiparesis, and persisting signs of meningeal irritation. A computerized tomography (CT) scan revealed subarachnoid and intraventricular hemorrhage. An angiogram revealed BA aplasia. The right PCoA followed a sinuous course with multiple loops and provided the dominant supply to the posterior circulation. This vessel harbored two aneurysms, one at the origin of the PCoA from the internal carotid artery and the other at the looping segment just proximal to the brainstem. The left PCoA was extremely thin. The pterional transsylvian approach was used to clip the two aneurysms on the PCoA.
The hemodynamic changes produced by the BA aplasia may have produced alterations in the cerebral vasculature leading to aneurysm formation and consequent subarachnoid hemorrhage.
Monitoring and preventing blood flow insufficiency due to clip rotation after the treatment of internal carotid artery aneurysms
Authors: Sakuma Jun , Suzuki Kyouichi , Sasaki Tatsuya , Matsumoto Masato , Oinuma Masahiro , Kawakami Masahisa , Itakura Takeshi , Kodama Namio 
Published: May 2009

✓ The authors report a case in which anterior choroidal artery (AChA) blood flow insufficiency due to aneurysm clip rotation was detected intraoperatively by motor evoked potential (MEP) monitoring and ischemia was successfully avoided.
The patient had an incidentally discovered aneurysm for which occlusion of its neck was performed through a standard frontotemporal craniotomy without changing the MEP amplitude. After it was confirmed that the surrounding arteries were not stenotic, the brain retractor on the frontal lobe was released; MEP amplitude subsequently decreased. Rotation of the clip toward the frontal base by repositioning of the frontal lobe caused the AChA stenosis at the origin of its branches. On reorienting the clip toward the frontal lobe, the AChA stenosis was released and MEP amplitude recovered. To prevent repeated clip rotation, a large amount of gelatin (Spongel) was inserted between the frontal base and the clip. The authors confirmed that clip rotation did not occur after repositioning of the frontal lobe. Motor evoked potential amplitude was maintained until dural closure. Postoperatively, the patient demonstrated no neurological deficit and there was no newly developed low-density area on computerized tomography scans.
W. James Gardner: pioneer neurosurgeon and inventor
Authors: Nathoo Narendra , Mayberg Marc R. , Barnett Gene H. 
Published: May 2009

✓ W. James Gardner, a skillful neurosurgeon and inventor, is best remembered for his cervical tongs and hydrodynamic theory of syringomyelia.
A pioneer of modern neurosurgery, Gardner trained under Charles Frazier in Philadelphia, and in 1929 he moved to Ohio where he became chief of neurosurgery at the Cleveland Clinic, a position he was to hold for the next 33 years. A large surgical practice made it imperative for Gardner to develop surgical methods that were quick, effective, and advantageous for patient and surgeon. He was an early proponent of the sitting position for patients undergoing cranial surgery, which led to the development of a neurosurgical chair with a head fixation device. To reduce the risks of hypotension and air embolism when the patient is in the sitting position, Gardner invented the clinical G suit. He was the first to advocate and use induced arterial hypotension for intracranial surgery and the first neurosurgeon in the US to publish his experiences performing lumbar discography. He converted an operating table so that he could induce hypothermia during aneurysm surgery and then applied pneumatic cuffs to occlude the major arterial supply to the brain. His pioneering work has been documented in many other areas such as hemifacial spasm and trigeminal neuralgia, for which he performed the first vascular decompression, in cervical sympathectomy for treatment of various ailments, and in the use of intrathecally delivered steroid drugs for sciatica. During his career, he authored 256 publications and one book on the dysraphic states. Many of his contributions to the discipline of neurosurgery are now taken for granted.
The mechanism and effect of chronic electrical stimulation of the globus pallidus for treatment of Parkinson disease
Authors: Ogura Mitsuhiro , Nakao Naoyuki , Nakai Ekini , Uematsu Yuji , Itakura Toru 
Published: May 2009

Object. Although chronic electrical stimulation of the globus pallidus (GP) has been shown to ameliorate motor disabilities in Parkinson disease (PD), the underlying mechanism remains to be clarified. In this study the authors explored the mechanism for the effects of deep brain stimulation of the GP by investigating the changes in neurotransmitter levels in the cerebrospinal fluid (CSF) during the stimulation.
Methods. Thirty patients received chronic electrical stimulation of the GP internus (GPi). Clinical effects were assessed using the Unified PD Rating Scale (UPDRS) and the Hoehn and Yahr Staging Scale at 1 week before surgery and at 6 and 12 months after surgery. One day after surgery, CSF samples were collected through a ventricular tube before and 1 hour after GPi stimulation. The concentration of neurotransmitters such as γ-aminobutyric acid (GABA), noradrenaline, dopamine, and homovanillic acid (HVA) in the CSF was measured using high-performance liquid chromatography.
The treatment was effective for tremors, rigidity, and drug-induced dyskinesia. The concentration of GABA in the CSF increased significantly during stimulation, although there were no significant changes in the level of noradrenaline, dopamine, and HVA. A comparison between an increased rate of GABA concentration and a lower UPDRS score 6 months postimplantation revealed that the increase in the GABA level correlated with the stimulation-induced clinical effects.
Conclusions. Stimulation of the GPi substantially benefits patients with PD. The underlying mechanism of the treatment may involve activation of GABAergic afferents in the GP.
Three-dimensional visualization of neurovascular relationships in the posterior fossa: technique and clinical application
Authors: Naraghi Ramin , Hastreiter Peter , Tomandl Bernd , Bonk Agatha , Huk Walter , Fahlbusch Rudolf 
Published: May 2009

Object. The goal of this study was to describe the authors' technique for three-dimensional (3D) visualization of neurovascular relationships in the posterior fossa at the surface of the brainstem. This technique is based on the processing of high-resolution magnetic resonance (MR) imaging data. The principles and technical details involved in the accurate simultaneous visualization of vessels and cranial nerves as tiny structures are presented using explicit and implicit segmentation as well as volume rendering.
Methods. In this approach 3D MR constructive interference in steady state imaging data served as the source for image processing, which was performed using the Linux-based software tools SegMed for segmentation and Qvis for volume rendering. A sequence of filtering operations (including noise reduction and closing) and other software tools such as volume growing are used for a semiautomatic coarse segmentation. The subsequent 3D visualization in which implicit segmentation is used for the differentiation of cranial nerves, vessels, and brainstem is achieved by allocating opacity and color values and adjusting the related transfer functions. This method was applied to the presurgical evaluation in a consecutive series of 55 patients with neurovascular compression syndromes and the results were correlated to surgical findings. The potential for its use, further developments, and remaining problems are discussed.
Conclusions. This method provides an excellent intraoperative real-time virtual view of difficult anatomical relationships.
Recombinant vesicular stomatitis virus vectors as oncolytic agents in the treatment of high-grade gliomas in an organotypic brain tissue slice—glioma coculture model
Authors: Duntsch Christopher D. , Zhou Qihong , Jayakar Himangi R. , Weimar James D. , Robertson Jon H. , Pfeffer Lawrence M. , Wang Lie , Xiang Zixiu , Whitt Michael A. 
Published: May 2009

Object. The purpose of this study was to evaluate both replication-competent and replication-restricted recombinant vesicular stomatitis virus (VSV) vectors as therapeutic agents for high-grade gliomas by using an organotypic brain tissue slice—glioma coculture system.
Methods. The coculture system involved growing different brain structures together to allow neurons from these tissues to develop synaptic connections similar to those found in vivo. Rat C6 or human U87 glioma cells were then introduced into the culture to evaluate VSV as an oncolytic therapy. The authors found that recombinant wild-type VSV (rVSV-wt) rapidly eliminated C6 glioma cells from the coculture, but also caused significant damage to neurons, as measured by a loss of microtubule-associated protein 2 immunoreactivity and a failure in electrophysiological responses from neurons in the tissue slice. Nonetheless, pretreatment with interferon beta (IFNβ) virtually eliminated VSV infection in healthy tissues without impeding any oncolytic effects on tumor cells. Despite the protective effects of the IFNβ pretreatment, the tissue slices still showed signs of cytopathology when exposed to rVSV-wt. In contrast, pretreatment with IFNβ and inoculation with a replication-restricted vector with its glycoprotein gene deleted (rVSV-ΔG) effectively destroyed rat C6 and human U87 glioma cells in the coculture, without causing detectable damage to the neuronal integrity and electrophysiological properties of the healthy tissue in the culture.
Conclusions. Data in this study provide in vitro proof-of-principle that rVSV-ΔG is an effective oncolytic agent that has minimal toxic side effects to neurons compared with rVSV-wt and therefore should be considered for development as an adjuvant to surgery in the treatment of glioma.
Involvement of epidermal growth factor receptor—protein tyrosine kinase transactivation in endothelin-1—induced vascular contraction
Authors: Kawanabe Yoshifumi , Masaki Tomoh , Hashimoto Nobuo 
Published: May 2009

Object.Endothelin-1 (ET-1) is one of the major inducers of vasospasm following subarachnoid hemorrhage (SAH). It is generally accepted that extracellular signal—regulated kinase 1 and 2 (ERK1/2) are involved in ET-1—induced vascular contraction. In addition, ET-1 transactivates epidermal growth factor receptor (EGFR) protein tyrosine kinase (PTK), which leads to ERK1/2 stimulation. Therefore, the authors examined whether EGFR—PTK transactivation contributes to ET-1—induced vascular contraction in this study.Methods.Mitogen-activated protein kinase inhibitor, PD98059, inhibited ET-1—induced ERK1/2 stimulation in rabbit basilar artery (BA) vascular smooth-muscle cells (VSMCs). Moreover, PD98059 inhibited ET-1—induced contraction of rabbit BA rings. A specific inhibitor of EGFR PTK, AG1478, inhibited ET-1—induced EGFR—PTK transactivation, ERK1/2 stimulation, and contraction of BA rings in a concentration-dependent manner. The concentration of AG1478 required for 50% inhibition of the ET-1—induced contraction of BA rings was similar to that for ET-1—induced EGFR—PTK transactivation. Furthermore, AG1478 also inhibited ET-1—induced BA vasospasm in vivo.Conclusion.The results indicate that EGFR—PTK transactivation pathway plays an important role in ET-1—induced vascular contraction.
Devastating complications from alcohol cauterization of recurrent Rathke cleft cyst
Authors: Hsu Hugo Y. , Piva Alfio , Sadun Alfredo A. 
Published: May 2009

✓ Rathke cleft cysts are commonly found on autopsy but are seldom symptomatic. Conventional treatment of these lesions consists of transsphenoidal drainage with partial excision of the cyst, and recurrence is rare. Alternatively, the instillation of absolute alcohol into the cyst has been described in several reports, with no complications. The authors report on a woman with Rathke cleft cyst that recurred three times after the initial treatment; the lesion was treated with alcohol cauterization on the final recurrence with devastating complications.
This 51-year-old woman presented in 1992 with headaches and visual disturbances. Admission magnetic resonance imaging revealed a sellar/suprasellar lesion that was treated with conventional surgery and was subsequently confirmed to be a Rathke cleft cyst. The patient again presented with recurrence of the cyst at 22, 26, and 31 months after the initial presentation. On the final recurrence the cyst was treated with alcohol cauterization. Postoperatively, the patient awoke blind and suffered a seizure from leakage of the alcohol. The patient remains completely blind in both eyes and is also anosmic and has left lid ptosis and exotropia, which signify damage to the first through third cranial nerves.
Rathke cleft cysts have been known to recur after primary surgery; however, this is the first report of a single cyst recurring three times despite conventional surgical treatment. Additionally, this is the first report in which devastating complications from alcohol cauterization of the cyst have been described. The authors therefore advocate caution when attempting alcohol cauterization and advise that meticulous care be taken to ensure the patency of the cyst.
To everything there is a season and a time to every purpose: retirement and the neurosurgeon
Authors: Rovit Richard L. 
Published: May 2009

✓ Neurosurgery has designed a rigid curriculum that must be followed precisely by those who wish to enter the specialty. A similar process at the other end of the practice cycle has never been formalized except for mandatory retirement from certain administrative positions at a particular age. Basic considerations for strategic decision making about voluntary retirement from neurosurgery, especially operative neurosurgery, are investigated.
Statistical data from the US Census Bureau and sources in the medical literature were reviewed regarding life expectancy and retirement ages. Age-related differences in verbal and performance intelligence quotients, attention span, verbal memory recall, and visuospatial facility were surveyed. A questionnaire was sent to 29 recently retired academic neurosurgeons about their age and reasons for retirement along with postretirement activities; 22 responses were received.
Analysis of the data indicates that surgeons are now retiring at the age of approximately 60 years, whereas life expectancy is approximately 80 years. An individual thus may have 15 to 20 productive years after leaving active neurosurgical practice. Reasons for retirement among the 22 responding neurosurgeons included decreasing personal satisfaction and financial rewards, a desire to pursue other activities, local ground rules mandating age-specific retirement, the general sense that enough is enough, and, overall, a strong desire to stop performing surgery while at the top of one's game. The process of age-related competence assessment of commercial airline pilots is outlined, and a similar process of assessment of practicing surgeons may be warranted, with consideration for mandatory retirement from operative neurosurgery.
Selective disconnection of cortical venous reflux as treatment for cranial dural arteriovenous fistulas
Authors: van Dijk J. Marc C. , TerBrugge Karel G. , Willinsky Robert A. , Wallace M. Christopher 
Published: May 2009

Object. A single-institution series of 119 consecutive patients with a dural arteriovenous fistula (DAVF) and cortical venous reflux was reviewed to assess the overall clinical outcome of multidisciplinary management after long-term follow up. The selective disconnection of the cortical venous reflux compared with the obliteration of the entire DAVF was evaluated.
Methods. Dural arteriovenous fistulas in patients in this series were diagnosed between 1984 and 2001, and treatment was instituted in 102 of them. The outcome of adequately treated patients was compared with that of a control group consisting of those with persistent cortical venous reflux and with data found in the literature. In cases of combined dural sinus drainage and cortical venous reflux, a novel treatment concept of selective disconnection of the cortical venous reflux that left the sinus drainage intact, and thus converted the aggressive DAVF into a benign lesion, was evaluated.
Endovascular treatment, which was instituted initially in 78 patients, resulted in an obliteration or selective disconnection in 26 (25.5%) of 102 cases. In 70 cases (68.6%) the DAVFs were surgically obliterated or disconnected. In six cases (5.9%), patients were left with persistent cortical venous reflux. No lasting complications were noted in this series. Follow-up angiography confirmed a durable result in 94 (97.9%) of 96 adequately treated cases, at a mean follow up of 27.6 months (range 1.4–138.3 months).
Selective disconnection was performed in 23 DAVFs with combined sinus drainage and cortical venous reflux. These patients' long-term outcomes were equal to those with obliterated DAVFs, and the complication rate was lower.
Conclusions. Considering the ominous course of DAVFs with patent cortical venous reflux, multidisciplinary treatment of these lesions is highly effective and the complication rate is low. Selective disconnection provides a valid treatment option of DAVFs with combined dural sinus drainage and cortical venous reflux, as has been shown in cranial DAVFs with direct cortical venous reflux.
Unilateral stimulation of the subthalamic nucleus in Parkinson disease: a double-blind 12-month evaluation study
Authors: Germano Isabelle M. , Gracies Jean-Michel , Weisz Donald J. , Tse Winona , Koller William C. , Olanow C. Warren 
Published: May 2009

Object. Bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been established as an effective treatment for Parkinson disease (PD). Nevertheless, bilateral surgical procedures can be associated with frequent and severe complications. The aim in the present study was to assess the safety and efficacy of unilateral STN stimulation, and the need for a second procedure.
Methods. Twelve patients with PD underwent unilateral DBS of the STN and were followed up for 12 months. Patients were assessed at baseline and at each visit in a double-blind fashion by analyzing the Unified PD Rating Scale (UPDRS), ambulation speed, and home diaries.
Levodopa-off/stimulation-on UPDRS motor scores were improved by 26 ± 8% (p < 0.05, mean ± standard deviation [SD]) compared with the baseline levodopa-off score; there was a 50% improvement in contralateral features, a 17% improvement ipsilaterally, and a 36% improvement in axial features. The mean ambulation speed increased by 83 ± 44% (p < 0.01, mean ± SD). The medication-on time with dyskinesias was significantly reduced (p < 0.01) and the daily levodopa dose was reduced by 19 ± 6% (p < 0.05, mean ± SD). There were no clinically significant side effects.
Conclusions. Unilateral DBS of the STN is safe and well tolerated, and may provide sufficient benefit so that additional surgery is not required.